Advances in cerebral monitoring for the patient with traumatic brain injury.

A brief overview of the most common invasive and noninvasive monitoring tools collectively referred to using the term "multimodal monitoring" is provided. Caring for the critically ill patient with traumatic brain injury requires careful monitoring to prevent or reduce secondary brain injury. Concurrent to the growth of the subspecialty of neurocritical care, there has been a concerted effort to discover novel mechanisms to monitor the physiology of brain injury. The past 2 decades have witnessed an exponential growth in neurologic monitoring in terms of intracranial pressure, blood flow, metabolism, oxygenation, advanced neuroimaging, and electrophysiology.

Mahdavi Z ，Pierre-Louis N ，Ho TT ，Figueroa SA ，Olson DM ... -  《-》

[Multimodal Neuromonitoring and its Impact on Therapeutic and Diagnostic Decisions in Critical Ill Patients].

Patients with acute cerebral injuries for various reasons (traumatic, ischemic, hemorrhagic) are at risc for developing secondary brain damage and further neurological deterioration. The aim of neuromonitoring is to recognize subtile changes in intracranial physiology as early as possible to initiate adequate diagnostic and therapeutic measures to prevent secondary brain damage. Beside the classic method of clinical neuromonitoring in awake patients, implantation of intracranial probes to monitor intracranial pressure, brain tissue oxygenation and brain metabolism are used in comatose patients. Electrophysiological monitoring by electrocorticography or evoked potentials and measurement of cerebral blood flow provide additional information.The indications and clinical impact of these various monitoring techniques are discussed to ensure optimal medical care in patients with acute brain injury.

Reithmeier T ，Isaak R ，Sanchez-Porres R 《-》

The Role of Multimodal Invasive Monitoring in Acute Traumatic Brain Injury.

This article reviews the role of modalities that directly monitor brain parenchyma in patients with severe traumatic brain injury. The physiology monitored involves compartmental and perfusion pressures, tissue oxygenation and metabolism, quantitative blood flow, pressure autoregulation, and electrophysiology. There are several proposed roles for this multimodality monitoring, such as to track, prevent, and treat the cascade of secondary brain injury; monitor the neurologically injured patient; integrate various data into a composite, patient-specific, and dynamic picture; apply protocolized, pathophysiology-driven intensive care; use as a prognostic marker; and understand pathophysiologic mechanisms involved in secondary brain injury to develop preventive and abortive therapies, and to inform future clinical trials.

Lazaridis C ，Robertson CS 《-》

Subdural Empyema in the Setting of Multimodal Intracranial Monitoring.

Multimodal intracranial monitoring is becoming an increasingly common tool in the management of patients with traumatic brain injury. Although numerous reports detailing the benefits of such advanced monitoring exist in the literature, there is minimal discussion of the possible complications that may arise in this patient population. We report the case of a 32-year-old patient who had been assaulted and presented initially at an outside facility with a Glasgow Coma Scale score of 8. After transfer to our hospital, his Glasgow Coma Scale score was noted at 7T and multimodal monitoring with the Integra Licox brain tissue oxygen monitor and the Hemedex Bowman perfusion monitor was implemented, along with an external ventricular drain when a standard intracranial pressure monitor indicated increasing intracranial pressure. The patient's intracranial pressure normalized but he did require a course of antibiotics during this time for a fever and methicillin-resistant Staphylococcus aureus. The patient subsequently developed multifocal subdural empyemas requiring surgical evacuation. Postoperatively, the patient's intraoperative cultures remained without bacterial growth, likely related to the 2-week broad-spectrum antibiotic use. To our knowledge, this is the first reported incidence of a subdural empyema developing in this setting. Although the safety profile of multimodal intracranial modeling is excellent, with increasing numbers of invasive bedside procedures, neurosurgeons must remain acutely vigilant for the development of infectious complications.

Guan J ，Spivak ES ，Wilkerson C ，Park MS ... -  《-》

Advanced monitoring in traumatic brain injury: microdialysis.

Carpenter KL ，Young AM ，Hutchinson PJ 《-》