Neuromonitoring in Critically Ill Patients

• Published in: Critical care medicine Vol. 51; no. 4; pp. 525 - 542
• Main Authors: Rajagopalan, Swarna, Sarwal, Aarti
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-04-2023
• Subjects: Brain Injuries - diagnosis; Brain Injuries - therapy; Brain Injuries, Traumatic - complications; Brain Injuries, Traumatic - diagnosis; Brain Injuries, Traumatic - therapy; Cerebrovascular Circulation - physiology; Critical Care - methods; Critical Illness - therapy; Humans; Monitoring, Physiologic - methods
• ISSN: 0090-3493; 1530-0293
• DOI: 10.1097/CCM.0000000000005809

Critically ill patients are at high risk of acute brain injury. Bedside multimodality neuromonitoring techniques can provide a direct assessment of physiologic interactions between systemic derangements and intracranial processes and offer the potential for early detection of neurologic deterioration before clinically manifest signs occur. Neuromonitoring provides measurable parameters of new or evolving brain injury that can be used as a target for investigating various therapeutic interventions, monitoring treatment responses, and testing clinical paradigms that could reduce secondary brain injury and improve clinical outcomes. Further investigations may also reveal neuromonitoring markers that can assist in neuroprognostication. We provide an up-to-date summary of clinical applications, risks, benefits, and challenges of various invasive and noninvasive neuromonitoring modalities.
English articles were retrieved using pertinent search terms related to invasive and noninvasive neuromonitoring techniques in PubMed and CINAHL.
Original research, review articles, commentaries, and guidelines.
Syntheses of data retrieved from relevant publications are summarized into a narrative review.
A cascade of cerebral and systemic pathophysiological processes can compound neuronal damage in critically ill patients. Numerous neuromonitoring modalities and their clinical applications have been investigated in critically ill patients that monitor a range of neurologic physiologic processes, including clinical neurologic assessments, electrophysiology tests, cerebral blood flow, substrate delivery, substrate utilization, and cellular metabolism. Most studies in neuromonitoring have focused on traumatic brain injury, with a paucity of data on other clinical types of acute brain injury. We provide a concise summary of the most commonly used invasive and noninvasive neuromonitoring techniques, their associated risks, their bedside clinical application, and the implications of common findings to guide evaluation and management of critically ill patients.
Neuromonitoring techniques provide an essential tool to facilitate early detection and treatment of acute brain injury in critical care. Awareness of the nuances of their use and clinical applications can empower the intensive care team with tools to potentially reduce the burden of neurologic morbidity in critically ill patients.