Monitoring in the Neurocritical Care Unit

Abstract

Neuromonitoring is the hallmark of intensive care units in critically ill brain-injured patients. Neurologic examination is fundamental, still, however, not always applicable in patients with altered mental status, language disorders or those who are sedated and/or mechanically ventilated. Therefore, other methods of monitoring are suitable. Older neurologic monitoring techniques including monitoring intracranial pressure, cerebral perfusion pressure, jugular venous oxygenation, transcranial Doppler sonography and continuous electroencephalogram together with newer techniques such as cerebral microdialysis, brain tissue oxygenation and cerebral near-infrared spectroscopy are now more often used in neurointensive care. These methods have important limitations when used as standalone parameters. Multimodal monitoring, a combination of these techniques, may be able to provide more detailed, accurate and timely information regarding a patient’s status. However, few data exist on the many possible combinations of parameters, and some of the newer techniques remain unproven in benefit.