 |
Multimodality Neurosurgical Intensive
Care Monitoring
Evolving Standard of
Care
In the 1980's, due in large part to the efforts
of Camino Laboratories (later acquired by
Integra LifeSciences), the monitoring of intracranial
pressure (ICP) became an enduring standard of care
in the management of traumatic brain injury.
|
 |
|
While ICP monitoring is still unquestionably
of great value, elevated ICP is a rather late-stage indicator of the patient's
status and probable clinical outcome, and much research has been directed to the
development of diagnostic tools that will shed more light on intracranial dynamics
and hopefully improve management and outcomes.
Many new sensor technologies which permit the monitoring of important physical
and chemical quantities including cerebral
blood flow (CBF), partial pressures of brain
tissue oxygen and carbon
dioxide, pH,
temperature, and the concentrations of various
metabolites and ions via microdialysis,
hold great promise in this quest, but to date most have yet to realize their potentials.
The reason is obvious: the real clinical value of these new data lies not in isolated
individual parameters but in the relationships between and among them.
|
|
|
|
|
|
| |
|
|
True Multimodality Monitoring
The simplest example of true multimodality neuromonitoring
can be seen in the well known clinical indicator, cerebral
autoregulation. Simply put, the normal brain regulates its own blood supply,
resulting in relatively constant blood flow (CBF) over a wide range of blood pressure
values.The presence or absence of autoregulation in the clinical setting is typically
calculated sporadically using time-delayed (by hours or even days) ICP, CBF and
BP data recorded in a patient's chart. In contrast, a
true multimodality monitor that displays the CBF
plotted against the blood pressure or CPP, is actually visualizing, in real-time,
this important clinical indicator.
|
|
|
In the same way, many other data relationships may be visualized by consolidating
parameters from multiple individual monitoring systems and displaying them, in
real-time, in clinically useful formats.
The result is true multimodality neuromonitoring. |
|
|
| |
|
|
|
