Anest. intenziv. Med. 2010;21(2):104-111

Multimodal monitoring in neurointensive care of severe traumatic brain injuryIntesive Care Medicine - Review Article

Hejčl Aleš1,*, Bolcha Martin1, Procházka Jan2, Hušková Eva3, Sameš Martin1
1 Neurochirurgická klinika Univerzity Jana Evangelisty Purkyně, Krajská zdravotní, a. s., Masarykova nemocnice, o. z., Ústí nad Labem
2 Centrální JIP, Krajská zdravotní, a. s., Masarykova nemocnice, o. z., Ústí nad Labem
3 Oddělení ARIM, Krajská zdravotní, a. s., Masarykova nemocnice, o. z., Ústí nad Labem

The therapy of traumatic brain injury consists of prevention and therapy of secondary injury. Proper and early diagnosis is necessary for adequate treatment. Standard monitoring methods in today's neurointensive care include clinical observation, intracranial pressure monitoring and repeated brain CT scans. During the last 10 years, new methods have been implemented in clinical practice that can improve our understanding of the pathophysiology of brain injury and provide early diagnosis of secondary trauma. These methods include tissue oxymetry, microdialysis and brain tissue blood flow. Their common application constitutes so called multimodal monitoring. In the following review we introduce these methods in neurointensive care. Further, we summarize our experience with 50 patients with multimodal monitoring since 2006.

Keywords: head trauma; multimodal monitoring; intracranial pressure; tissue oxymetry; microdialysis; cerebral blood flow

Published: April 1, 2010  Show citation

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Hejčl A, Bolcha M, Procházka J, Hušková E, Sameš M. Multimodal monitoring in neurointensive care of severe traumatic brain injury. Anest. intenziv. Med. 2010;21(2):104-111.
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    References

    1. Smrčka, M. Poranění mozku. 1. vyd. Praha: Grada Publishing, 2001, 278 s. ISBN 80-7169-820-2.
    2. Náhlovský, J. Neurochirurgie. 1. vyd. Praha: Galén, 2006, 581 s. ISBN 80-7262-319-2.
    3. Miller, J. D., Becker, D. P., Ward, J. D., Sullivan, H. G., Adams, W. E., Rosner, M. J. Significance of intracranial hypertension in severe head injury. J Neurosurg., 1977, 47, p. 503-516. Go to original source... Go to PubMed...
    4. Monro, A. Observation on the Structure and the Function of the Nervous System. Edinburgh: Creek Johnson, 1783.
    5. Kellie, G. An account of the appearance observed in the dissection of two of three individuals presumed to have perished in the storm of the 3D and whose bodies were discovered in the vicinity of Leith on the morning of the 4th November 1821, with some reflections on the pathology of the brain. Trans. Med. Chir. Sci. Edinb., 1824, 1, p. 84.
    6. Lundberg, N. Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiat Neurol Scand (Suppl), 1960, 149, p. 1-193.
    7. Lozier, A. P., Sciacca, R. R., Romagnoli, M. F., Connolly, E. S. Jr. Ventriculostomy-related infections: a critical review of the literature. Neurosurgery, 2002, 51, p. 170-181. Go to original source... Go to PubMed...
    8. Mayhall, C. G., Archer, N. H., Lamb, V. A., Spadora, A. C., Baggett, J. W., Ward, J. D., Narayan, R. K. Ventriculostomy-related infections. A prospective epidemiologic study. N. Engl. J. Med., 1984, 310, p. 553-559. Go to original source...
    9. Lo, C. H., Spelman, D., Bailey, M., Cooper, D. J., Rosenfeld, J. V., Brecknell, J. E. External ventricular drain infections are independent of drain duration: an argument against elective revision. J. Neurosurg., 2007, 106, p. 378-383. Go to original source... Go to PubMed...
    10. Zabramski, J. M., Whiting, D., Darouiche, R. O., Horner, T. G., Olson, J., Robertson, C., Hamilton, A. J. Efficacy of antimicrobial impregnated external ventricular drain catheters: a prospective, randomized, controlled trial. J. Neurosurg., 2003, 98, p. 725-730. Go to original source... Go to PubMed...
    11. Birch, A. A., Eynon, C. A., Schley, D. Erroneous intracranial pressure measurements from simultaneous pressure monitoring and ventricular drainage catheters. Neurocrit. Care, 2006, 5, p. 51-54. Go to original source... Go to PubMed...
    12. The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Intracranial pressure thresholds. J. Neurotrauma, 2007, 24, p. 55-58
    13. Narayan, R. K., Kishore, P. R., Becker, D. P., Ward, J. D., Enas, G. G., Greenberg, R. P., Domingues, Da. S. A., Lipper, M. H., Choi, S. C., Mayhall, C. G., Lutz, H. A., III, Young, H. F. Intracranial pressure: tomonitor or not to monitor? A review of our experience with severe head injury. J. Neurosurg., 1982, 56, p. 650-659. Go to original source... Go to PubMed...
    14. Balestreri, M., Czosnyka, M., Hutchinson, P., Steiner, L. A., Hiler, M., Smielewski, P., Pickard, J. D. Impact of intracranial pressure and cerebral perfusion pressure on severe disability and mortalityafter head injury. Neurocrit. Care, 2006, 4, p. 8-13. Go to original source... Go to PubMed...
    15. Saul, T. G., Ducker, T. B. Effect of intracranial pressure monitoring and aggressive treatment on mortality in severe head injury. J. Neurosurg., 1982, 56, p. 498-503. Go to original source... Go to PubMed...
    16. Gibbs, E., Lennox, W., Nims, L. Arterial and cerebral venous blood: arterial-venous differences in man. J. Bio. Chem., 1942, 144, p. 324. Go to original source...
    17. Filaun, M., Horáček, M., Steindler, J., Pekař, L., Cvachovec, K. Monitorování mozkové oxygenace. Ces. Slov. Neurol. N., 2008, 71, s. 657-663.
    18. Stieffel, M. F., Udoetuk, J. D., Spiotta, A. M., Gracias, V. H., Goldberg, A., Maloney-Wilensky, E., Bloom, S., Le Roux, P. D. Conventional neurocritical care and cerebral oxygenation after traumatic brain injury. J. Neurosurg., 2006, 105, p. 568-575. Go to original source... Go to PubMed...
    19. Gopinath, S. P., Valadka, A. B., Uzura, M., Robertson, C. S. Comparison of jugular venous oxygen saturation and brain tissue PO2 as monitors of cerebral ischemia after head injury. Crit. Care Med., 1999, 27, p. 2337-2345. Go to original source... Go to PubMed...
    20. Johnston, A. J., Steiner, L. A., Coles, J. P., Chatfield, D. A., Fryer, T. D., Smielewski, P., Hutchinson, P. J., O'Connell, M. T., Al-Rawi, P. G., Aigbirihio, F. I., Clark, J. C., Pickard, J. D., Gupta, A. K., Menon, D. K. Effect of cerebral perfusion pressure augmentation on regional oxygenation and metabolism after head injury. Crit. Care Med., 2005, 33, p. 189-195. Go to original source... Go to PubMed...
    21. Kiening, K. L., Härtl, R., Unterberg, A. W., Schneider, G. H., Bardt, T., Lanksch, W. R. Brain tissue pO2-monitoring in comatose patients: implications for therapy. Neurol. Res., 1997, 19, p. 233-240. Go to original source... Go to PubMed...
    22. Jaeger, M., Soehle, M., Meixensberger, J. Brain tissue oxygen (PtiO2): a clinical comparison of two monitoring devices. Acta Neurochir. Suppl., 2005, 95, p. 79-81. Go to original source... Go to PubMed...
    23. Ungerstedt, U., Pycock, C. Functional correlates of dopamine neurotransmission. Bull. Schweiz. Akad. Med. Wiss., 1974, 30, s. 44-55. Go to PubMed...
    24. Martin, G. T., Bowman, H. F. Validation of real-time continuous perfusion measurement. Med. Biol. Eng. Comput., 2000, 38, p. 319-325. Go to original source... Go to PubMed...
    25. Stahl, N., Schalen, W., Ungerstedt, U., Nordstrom, C. H. Bedside biochemical monitoring of the penumbra zone surrounding an evacuated acute subdural haematoma. Acta Neurol. Scand., 2003, 108, p. 211-215. Go to original source... Go to PubMed...
    26. Bellander, B. M., Cantais, E., Enblad, P., Hutchinson, P., Nordström, C. H., Robertson, C., Sahuquillo, J., Smith, M., Stocchetti, N., Ungerstedt, U., Unterberg, A., Olsen, N. V. Consensus meeting on microdialysis in neurointensive care. Intensive Care Med., 2004, 30, p. 2166-2169. Go to original source... Go to PubMed...
    27. Dings, J., Meixensberger, J., Jäger, A., Roosen, K. Clinical experience with 118 brain tissue oxygen partial pressure catheter probes. Neurosurgery, 1998, 43, p. 1082-1095. Go to original source... Go to PubMed...
    28. Tisdall, M. M., Smith, M. Multimodal monitoring in traumatic brain injury: current status and future directions. Br. J. Anaesth., 2007, 99, p. 61-67. Go to original source... Go to PubMed...
    29. Bratton, S. L., Chestnut, R. M., Ghajar, J., McConnell Hammond, F. F., Harris, O. A., Hartl, R., Manley, G. T., Nemecek, A., Newell, D. W., Rosenthal, G., Schouten, J., Shutter, L., Timmons, S. D., Ullman, J. S., Videtta, W., Wilberger, J. E., Wright, D. W. Guidelines for the management of severe traumatic brain injury. X. Brain oxygen monitoring and thresholds. J. Neurotrauma, 2007, 24 Suppl 1, p. 65-70. Go to original source... Go to PubMed...
    30. Meixensberger, J., Jaeger, M., Väth, A., Dings, J., Kunze, E., Roosen, K. Brain tissue oxygen guided treatment supplementing ICP/CPP therapy after traumatic brain injury. J. Neurol. Neurosurg. Psychiatry, 2003, 74, p. 760-764. Go to original source... Go to PubMed...
    31. Belli, A., Sen, J., Petzold, A., Russo, S., Kitchen, N., Smith, M. Metabolic failure precedes intracranial pressure rises in traumatic brain injury: a microdialysis study. Acta Neurochir. (Wien), 2008, 150, p. 461-469. Go to original source... Go to PubMed...
    32. Kett-White, R., Hutchinson, P. J., Al-Rawi, P. G., Gupta, A. K., Pickard, J. D., Kirkpatrick, J. D. Cerebral oxygen and microdialysis monitoring during aneurysma Sumery: effects of blood pressure, cerebrospinal fluid drainage, and temporary clipping on infarction. J. Neurosurg., 2002, 96, p. 1013-1009. Go to original source... Go to PubMed...
    33. Smrčka, M., Ďuriš, K., Juráň, V., Neumann, E., Kýr, M. Peroperační monitoring tkáňové oxymetrie a pooperační užití hypotermie v chirurgii mozkových aneuryzmat. Česk. Slov. Neurol., 2009, 72, p. 245-249.
    34. Rabinstein, A. A., Weigand, S., Atkinson, J. L., Wijdicks, E. F. Patterns of cerebral infarction in aneurysmal subarachnoid hemorrhage. Stroke, 2005, 36, p. 992-997. Go to original source... Go to PubMed...
    35. Skjøth-Rasmussen, J., Schulz, M., Kristensen, S. R., Bjerre, P. Delayed neurological deficits detected by an ischemic pattern in the extracellular cerebral metabolites in patients with aneurysmal subarachnoid hemorrhage. J. Neurosurg., 2004, 100, p. 8-15. Go to original source... Go to PubMed...
    36. Unterberg, A. W., Sakowitz, O. W., Sarrafzadeh, A. S., Benndorf, G., Lanksch, W. R. Role of bedside microdialysis in the diagnosis of cerebral vasospasm following aneurysmal subarachnoid hemorrhage. J. Neurosurg., 2001, 94, p. 740-749. Go to original source... Go to PubMed...
    37. Hejčl, A., Bolcha, M., Procházka, J., Sameš, M. Multimodální monitorování mozku u pacientů s těžkým kraniocerebrálním traumatem a subarachnoidálním krvácením v neurointenzivni peči. Česk. Slov. Neurol., 2009, 72, s. 383-387.
    38. Reinstrup, P., Ståhl, N., Mellergård, P., Uski, T., Ungerstedt, U., Nordström, C. H. Intracerebral microdialysis in clinical practice: baseline values for chemical markers during wakefulness, anesthesia, and neurosurgery. Neurosurgery, 2000, 47, p. 701-709. Go to original source... Go to PubMed...

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