Mauro Oddo1, Federico Villa, Giuseppe Citerio. 1. Department of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne University Hospital, Lausanne, Switzerland. mauro.oddo@chuv.ch
Abstract
PURPOSE OF REVIEW: An important goal of neurocritical care is the management of secondary brain injury (SBI), that is pathological events occurring after primary insult that add further burden to outcome. Brain oedema, cerebral ischemia, energy dysfunction, seizures and systemic insults are the main components of SBI. We here review recent data showing the clinical utility of brain multimodality monitoring (BMM) for the management of SBI. RECENT FINDINGS: Despite being recommended by international guidelines, standard intracranial pressure (ICP) monitoring may be insufficient to detect all episodes of SBI. ICP monitoring, combined with brain oxygen (PbtO(2)), cerebral microdialysis and regional cerebral blood flow, might help to target therapy (e.g. management of cerebral perfusion pressure, blood transfusion, glucose control) to patient-specific pathophysiology. Physiological parameters derived from BMM, including PbtO(2) and microdialysis lactate/pyruvate ratio, correlate with outcome and have recently been incorporated into neurocritical care guidelines. Advanced intracranial devices can be complemented by quantitative electroencephalography to monitor changes of brain function and nonconvulsive seizures. SUMMARY: BMM offers an on-line comprehensive scrutiny of the injured brain and is increasingly used for the management of SBI. Integration of monitored data using new informatics tools may help optimize therapy of brain-injured patients and quality of care.
PURPOSE OF REVIEW: An important goal of neurocritical care is the management of secondary brain injury (SBI), that is pathological events occurring after primary insult that add further burden to outcome. Brain oedema, cerebral ischemia, energy dysfunction, seizures and systemic insults are the main components of SBI. We here review recent data showing the clinical utility of brain multimodality monitoring (BMM) for the management of SBI. RECENT FINDINGS: Despite being recommended by international guidelines, standard intracranial pressure (ICP) monitoring may be insufficient to detect all episodes of SBI. ICP monitoring, combined with brain oxygen (PbtO(2)), cerebral microdialysis and regional cerebral blood flow, might help to target therapy (e.g. management of cerebral perfusion pressure, blood transfusion, glucose control) to patient-specific pathophysiology. Physiological parameters derived from BMM, including PbtO(2) and microdialysis lactate/pyruvate ratio, correlate with outcome and have recently been incorporated into neurocritical care guidelines. Advanced intracranial devices can be complemented by quantitative electroencephalography to monitor changes of brain function and nonconvulsive seizures. SUMMARY: BMM offers an on-line comprehensive scrutiny of the injured brain and is increasingly used for the management of SBI. Integration of monitored data using new informatics tools may help optimize therapy of brain-injured patients and quality of care.
Authors: Daniel Pinggera; Ruth Steiger; Marlies Bauer; Johannes Kerschbaumer; Markus Luger; Ronny Beer; Andreas Rietzler; Astrid E Grams; Elke R Gizewski; Claudius Thomé; Ondra Petr Journal: Neurocrit Care Date: 2021-04 Impact factor: 3.210
Authors: Wesley B Baker; Ramani Balu; Lian He; Venkaiah C Kavuri; David R Busch; Olivia Amendolia; Francis Quattrone; Suzanne Frangos; Eileen Maloney-Wilensky; Kenneth Abramson; Elizabeth Mahanna Gabrielli; Arjun G Yodh; W Andrew Kofke Journal: J Cereb Blood Flow Metab Date: 2019-05-14 Impact factor: 6.200
Authors: Rupert Faltermeier; Martin A Proescholdt; Sylvia Bele; Alexander Brawanski Journal: Comput Math Methods Med Date: 2015-03-03 Impact factor: 2.238
Authors: Kanokwan Limnuson; Raj K Narayan; Amrit Chiluwal; Eugene V Golanov; Chad E Bouton; Chunyan Li Journal: Front Neurosci Date: 2016-08-19 Impact factor: 4.677