Multimodality Monitoring in Neurocritical Care: Decision-Making Utilizing Direct And Indirect Surrogate Markers

J Intensive Care Med. 2019 Jun;34(6):449-463. doi: 10.1177/0885066618788022. Epub 2018 Sep 11.

Abstract

Substantial progress has been made to create innovative technology that can monitor the different physiological characteristics that precede the onset of secondary brain injury, with the ultimate goal of intervening prior to the onset of irreversible neurological damage. One of the goals of neurocritical care is to recognize and preemptively manage secondary neurological injury by analyzing physiologic markers of ischemia and brain injury prior to the development of irreversible damage. This is helpful in a multitude of neurological conditions, whereby secondary neurological injury could present including but not limited to traumatic intracranial hemorrhage and, specifically, subarachnoid hemorrhage, which has the potential of progressing to delayed cerebral ischemia and monitoring postneurosurgical interventions. In this study, we examine the utilization of direct and indirect surrogate physiologic markers of ongoing neurologic injury, including intracranial pressure, cerebral blood flow, and brain metabolism.

Keywords: multimodality monitoring; neurocritical care.

Publication types

  • Review

MeSH terms

  • Biomarkers / analysis
  • Brain / blood supply*
  • Brain Injuries / diagnosis*
  • Brain Injuries / physiopathology
  • Brain Injuries / therapy
  • Brain Ischemia / diagnosis*
  • Brain Ischemia / physiopathology
  • Critical Care*
  • Decision Support Systems, Clinical
  • Humans
  • Intracranial Pressure / physiology
  • Models, Neurological
  • Neurophysiological Monitoring* / methods

Substances

  • Biomarkers