HARD DECISIONS IN INTENSIVE CARE UNIT

Intensivecareunitkapak

NOROMONITORING

İmren Taşkıran

Kocaeli City Hospital, Department of Intensive Care, Kocaeli, Türkiye

Taşkıran İ. Noromonitoring. In: Turan S, editor. Hard Decisions in Intensive Care Unit. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.403-415.

ABSTRACT

Early detection and treatment of acute brain injury and prevention of secondary brain injury in critically ill patients are extremely important. Therefore, in the management of critically ill patients with acute brain injury, methods such as real-time neurophysiological monitoring in critically ill patients are needed to detect brain damage early and prevent irreversible damage. Neuromonitoring techniques that can be used at the bedside in the critically ill patient may provide important information for direct assessment of physiological interactions between systemic disorders and intracranial processes and for early detection of neurological deterioration before clinically apparent signs and symptoms become evident. Multimodal monitoring of brain functions is of vital importance to evaluate the patient’s brain functions. Although many devices and methods have been developed to monitor brain functions, developments in this field continue rapidly today. Neuromonitoring involves continuous or intermittent measurement of physiological parameters in the brain and/or surrounding tissues. These parameters include intracranial pressure (ICP), cerebral blood flow (CBF), cerebral oxygenation, cerebral oxygen

flow (CDO2), brain tissue partial oxygen pressure (PbtO2), electroencephalography (EEG) patterns, somatosensory evoked potentials (SSEPs), brainstem auditory evoked potentials (BAEPs) and visual evoked potentials (VEPs) and some other parameters. By monitoring these variables, clinicians can

gain insight into brain function and integrity. They can detect any abnormalities or changes that may indicate new and/or evolving brain damage early and make early changes to the treatment approach. In neuromonitoring, there are multiple modalities supported for use, but the most basic recommended is always the initial neurological examination followed by sequential examinations during clinical follow-up. Each modality used today has its advantages and disadvantages. It helps us to know these in clinical practice and further increase their diagnostic value. Many centers recommend multimodal monitoring as an important feature of neurocritical care. The advantages of multimodal monitoring include taking into account the limitations of each monitoring modality and the fact that all these different techniques help to further elucidate the pathophysiology and underlying cellular mechanisms of the disease. It is also emphasized that the clinical data obtained through all these different monitoring methods should be integrated and synthesized by evaluating on an individual patient basis.

Keywords: Neurophysiological monitoring; Cerebrovascular circulation; Cerebral blood volume; Brain edema; Electrocorticography

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