Highly Accessed Review

Clinical review: Neuromonitoring - an update

Nino Stocchetti1*, Peter Le Roux2, Paul Vespa3, Mauro Oddo4, Giuseppe Citerio5, Peter J Andrews6, Robert D Stevens7, Tarek Sharshar8, Fabio S Taccone9 and Jean-Louis Vincent9

Author Affiliations

1 Milan University, Terapia Intensiva Neuroscienze, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy

2 Department of Neurosurgery, University of Pennsylvania, 235 S. 8th Street, Philadelphia, PA 19106, USA

3 Department of Neurosurgery, David Geffen School of Medicine at UCLA, 757 Westwood Blvd, Suite 6236A, Los Angeles, CA 90095, USA

4 Department of Critical Care Medicine, CHUV-University Hospital, Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 46, BH 08.623; CH-1011 Lausanne, Switzerland

5 Neuroanestesia e Neurorianimazione, Dipartimento di Medicina Perioperatoria e Terapie Intensive, H San Gerardo, Via Pergolesi 33, 20052 Monza, Italy

6 Center for Clinical Brain Sciences, Critical Care and Pain Medicine, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK

7 Division of Neuroscience Critical Care, Johns Hopkins University School of Medicine, Meyer 8-140, 600 N. Wolfe St, Baltimore, MD 21287, USA

8 Department of Intensive Care Medicine, Raymond Poincaré, Teaching Hospital and University of Versailles Saint-Quentin en Yvelines, 104 Boulevard Raymond Poincaré, 92380 Garches, France

9 Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, route de Lennik 808, 1070 Brussels, Belgium

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Critical Care 2013, 17:201  doi:10.1186/cc11513

Published: 15 January 2013

Abstract

Critically ill patients are frequently at risk of neurological dysfunction as a result of primary neurological conditions or secondary insults. Determining which aspects of brain function are affected and how best to manage the neurological dysfunction can often be difficult and is complicated by the limited information that can be gained from clinical examination in such patients and the effects of therapies, notably sedation, on neurological function. Methods to measure and monitor brain function have evolved considerably in recent years and now play an important role in the evaluation and management of patients with brain injury. Importantly, no single technique is ideal for all patients and different variables will need to be monitored in different patients; in many patients, a combination of monitoring techniques will be needed. Although clinical studies support the physiologic feasibility and biologic plausibility of management based on information from various monitors, data supporting this concept from randomized trials are still required.