Abstract
The ability to measure reliably the changes in the physical and biochemical environment after a brain injury is of great value in the prevention, treatment, and understanding of the secondary injuries. Three categories of multimodal brain monitoring exist: direct signals which are monitored invasively; variables which may be monitored noninvasively; and variables describing brain pathophysiology which are not monitored directly but are calculated at the bedside by dedicated computer software. Intracranial pressure (ICP) monitoring, either as stand-alone value or study of a dynamic trend, has become an important diagnostic tool in the diagnosis and management of multiple neurological conditions. Attempts have been made to measure ICP non-invasively, but this is not a clinical reality yet. There is contrasting evidence that monitoring of ICP is associated with better outcome, and further RCTs based on management protocol are warranted. Computer bedside calculation of “secondary parameters” has shown to be potentially helpful, particularly in helping to optimize “CPP-guided therapy.” In this paper we describe the most popular invasive and non invasive monitoring modalities, with great attention to their clinical interpretation based on the current published evidence.
Highlights
Brain injury occurs either at the time of a direct insult or subsequently due to changes in the physical and biochemical environment
Multimodal brain monitoring can be grouped into three categories: (1) direct signals which are monitored invasively (e.g., intracranial pressure (ICP), tissue oxygenation, microdialysis, parenchymal blood flow, etc.); (2) variables which may be monitored noninvasively (e.g., transcranial Doppler (TCD) or near infrared spectroscopy (NIRS)); (3) variables describing brain pathophysiology which are not monitored directly but are calculated at the bedside by dedicated computer software
The simplest example is the cerebral perfusion pressure (CPP), which is the difference between the mean arterial blood pressure (MAP) and the Intracranial Pressure (ICP) (CPP = MAP-ICP), and it is a calculated variable
Summary
Brain injury occurs either at the time of a direct insult or subsequently due to changes in the physical and biochemical environment. Multimodal brain monitoring can be grouped into three categories: (1) direct signals which are monitored invasively (e.g., intracranial pressure (ICP), tissue oxygenation, microdialysis, parenchymal blood flow, etc.); (2) variables which may be monitored noninvasively (e.g., transcranial Doppler (TCD) or near infrared spectroscopy (NIRS)); (3) variables describing brain pathophysiology which are not monitored directly but are calculated at the bedside by dedicated computer software.
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