Abstract
Monitoring the metabolism and function of the central nervous system not only is an old idea but also is a topic that is of increasing interest to the technological evolution. Beside the optimization of cerebral and spinal cord perfusion and the preservation of vasoreactivity to ensure the viability of cerebral tissues and structures, we want to know more and more about the real intimate situation of these organs in real time at the patient’s bedside. To this end, several tracks have been explored during the two last decades, leading to the development of numerous concepts and the conception of various monitoring systems. One of the main problems is to characterize the respective strong points and weaknesses of those ones and to conclude regarding their individual relevance and value in current clinical practice. It is more and more clear that the combination of different categories of monitoring is a way to try to find the most valuable technological compromise, to increase the chance of prediction or of early detection of intercurrent deleterious events corresponding to the concept of multimodality. The intraoperative period and the intensive care goals and targets are appreciably different. This is the reason for the attempt to define different and distinct sets of goals and targets for the intraoperative anesthetic setting and for the intensive care unit.
Highlights
The most accurate possible monitoring of the metabolism and function of the central nervous system (CNS) re-How to cite this paper: Pandin, P., Renard, M., Bianchini, A., Desjardin, P. and Van Obbergh, L. (2014) Monitoring Brain and Spinal Cord Metabolism and Function
For a long time the concept of active neuroprotection has been developed following the successive progress in the understanding of the complex interaction between the CNS, surgery, anesthesia, and/or a possible aggression
Strong evidence seems to lack when intracranial pressure (ICP) is considered to guide therapy in patients with acute brain injury [39] as illustrated by the recent Chesnut’s [40] randomized controlled trial which demonstrated the lack of difference in 3- or 6-month outcomes in severe traumatic brain injury patients whose treatment was based on the ICP monitoring compared with those whose the follow-up was based on imaging (CTscan) and clinical examination without ICP monitoring
Summary
The most accurate possible monitoring of the metabolism and function of the central nervous system (CNS) re-. (2014) Monitoring Brain and Spinal Cord Metabolism and Function. It makes possible the more and more adapted management of the brain and the spinal cord during either more and more complex and specificneurosurgical interventions or more and more invasive investigations in neuro-intensive care unit (Neuro-ICU). For a long time the concept of active neuroprotection has been developed following the successive progress in the understanding of the complex interaction between the CNS, surgery, anesthesia, and/or a possible aggression (trauma, hemorrhage, ischemia, anoxia, edema, etc.). Continuous efforts led to the conception of multimodal intraoperative monitoring (IOM), supported by pioneers as the American anesthesiologist Betty Grundy [2]-[4] and the English neurophysiologist Catherine Thornton [5] [6]
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