Neurointensive Care Monitoring for Severe Traumatic Brain Injury

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Worldwide, traumatic brain injury is one of the leading cause of permanent disability and death. Contextually, close monitoring and immediate therapy for any accompanying abnormalities are crucial in order to reduce the rate of mortality or morbidity associated with this acquired brain injury. For this purpose, an isolated neurointensive care (NIC) specialised for brain injury is highly warranted, manned by appropriately trained staff who understand the current pathophysiology of brain injury and equipped with various modes of therapy to tackle any diagnosed abnormalities. To date, we are witnessing progress in managing severely injured brain from no specific monitoring to specific ones, and from a single intracranial pressure monitoring to future trend of multiple cranial monitoring alongside availability of various mode of therapies. The multimodal brain monitoring as it is commonly known is a concept whereby, intracranial pressure as well as various other important cerebral parameters can readily be monitored. Monitoring alone will not alter the outcomes of severely injured brain patients. Prompt recognition of any abnormality from the monitoring and availability of therapy to correct the diagnosed abnormality are some of the factors that are recognised to influence better outcome score. However, at present, two obvious limitations in the multimodality brain monitoring are our incomplete understanding of the underlying pathophysiology of the severely injured brain and the limited availability of mode of therapy to the neurosurgeon or neurointensivist to treat abnormalities detected from the state-of-the-art monitoring. Research are ongoing in these areas and in this chapter, we discuss in details the current pathophysiology of traumatic brain injury, roles of multimodality brain monitoring in NIC and the prospects of brain hypothermia to correct commonly associated abnormal monitored-parameters.