Update on multimodality monitoring.

Brain injury is a dynamic process marked by an initial damaging insult followed by a cascade of physical, electrical, and metabolic changes capable of resulting in further patient disability. These subclinical changes should be detected at a time when therapeutic intervention is most efficacious and preemptive. Multimodality monitoring is the practice by which a variety of brain monitors are utilized to deliver care, specific to the needs of the individual patient, in an attempt to minimize secondary injury and long-term disability. Intracranial pressure, continuous electroencephalography, brain tissue oxygen, cerebral microdialysis, cerebral blood flow, and jugular oximetry monitoring have been utilized to direct treatment of the critical ill neurologic and neurosurgical patient. Optimization of monitoring technique and protocol is an ongoing effort of intensivists in the field of neurocritical care.