Multimodal monitoring in patients with acute brain injury - A survey from critical care providers

Dana Klavansky; Raquel Romero; Neha S Dangayach; Sarah E Nelson; John Liang; Alexandra Reynolds; Spyridoula Tsetsou

doi:10.1016/j.jcrc.2024.154806

Multimodal monitoring in patients with acute brain injury - A survey from critical care providers

J Crit Care. 2024 Mar 30:82:154806. doi: 10.1016/j.jcrc.2024.154806. Online ahead of print.

Authors

Dana Klavansky¹, Raquel Romero², Neha S Dangayach², Sarah E Nelson³, John Liang², Alexandra Reynolds², Spyridoula Tsetsou⁴

Affiliations

¹ Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA. Electronic address: Dana.Klavansky@mountsinai.org.
² Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA.
³ Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA; Department of Neurology, Tufts Medical Center, Boston, USA.
⁴ Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA; Department of Neurology and Neurosurgery, Baylor College of Medicine, Houston, USA.

PMID: 38555684
DOI: 10.1016/j.jcrc.2024.154806

Abstract

Background: Multimodal neuromonitoring (MMM) aims to improve outcome after acute brain injury, and thus admission in specialized Neurocritical Care Units with potential access to MMM is necessary. Various invasive and noninvasive modalities have been developed, however there is no strong evidence to support monitor combinations nor is there a known standardized approach. The goal of this study is to identify the most used invasive and non-invasive neuromonitoring modalities in daily practice as well as ubiquitousness of MMM standardization.

Methods: In order to investigate current availability and protocolized implementation of MMM among neurocritical care units in US and non-US intensive care units, we designed a cross-sectional survey consisting of a self-administered online questionnaire of 20 closed-ended questions disseminated by the Neurocritical Care Society.

Results: Twenty-one critical care practitioners responded to our survey with a 76% completion rate. The most commonly utilized non-invasive neuromonitoring modalities were continuous electroencephalography followed by transcranial doppler. The most common invasive modalities were external ventricular drain followed by parenchymal intracranial pressure (ICP) monitoring. MMM is most utilized in patients with subarachnoid hemorrhage and there were no differences regarding established institutional protocol, 24-h cEEG availability and invasive monitor placement between teaching and non-teaching hospitals. MMM is considered standard of care in 28% of responders' hospitals, whereas in 26.7% it is deemed experimental and only done as part of clinical trials. Only 26.7% hospitals use a computerized data integration system.

Conclusion: Our survey revealed overall limited use of MMM with no established institutional protocols among institutions. Ongoing research and further standardization of MMM will clarify its benefit to patients suffering from severe brain injury.

Keywords: Acute brain injury; Invasive neuromonitoring; Multimodal monitoring; Noninvasive neuromonitoring.