Auditory evoked responses in the management of acutely brain-injured children and adults.

In recent years, the role of auditory evoked responses (AERs) in the intensive care unit (ICU) setting has expanded dramatically for both pediatric and adult brain-injured patient populations. AERs have unique value in early identification and evaluation of peripheral auditory dysfunction that can result directly from head trauma or as a consequence of intensive medical therapy (such as prolonged intubation and ototoxic drugs). AERs can also be applied in evaluating and monitoring neurologic status during the acute period following a severe brain injury, similar to their common intraoperative use as a neurophysiologic monitor. This paper reviews factors influencing measurement of AERs in the ICU, including the effect of (1) intensive medical therapy (e.g., neuromuscular blockers, sedatives, barbiturates, aminoglycosides, and loop diuretics); (2) coma; and (3) computed tomography confirmed temporal bone fracture. The rationale for monitoring neurologic status with AERs in this setting is presented and supported with original group data. Important points are illustrated with selected case reports.