Abstract
Monitoring technologies assume particular importance in the neurosciences critical care unit (NSU). Beyond the cardiac and respiratory monitoring modalities common to other intensive care units (ICU), the NSU uses a wide array of technologies for both whole brain monitoring and regional or focal brain monitoring (Table 1). This chapter addresses these brain monitoring modalities and also considers recent advances in general ICU monitoring strategies that are equally important to the welfare of the NSU patient.
Keywords
- Cerebral Blood Flow
- Mean Arterial Pressure
- Cerebral Perfusion Pressure
- Laser Doppler Flowmetry
- Severe Head Injury
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References
Jordan KG. Neurophysiologic monitoring in the neuroscience intensive care unit. Neurol. Clin. 1995; 13: 579–626.
Rosner MJ. Pathophysiology and management of increased intracranial pressure. In: Andrews BT, ed. Neurosurgical Intensive Care. New York: McGraw-Hill, 1993, pp. 57–112.
Lang EW, Chestnut RM. Intracranial pressure: Monitoring and management. Neurosurg. Clin. North Am. 1994; 5: 573–588.
Lundberg N. Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr. Scand. 1960; 36 (Suppl 149): 1.
Guyot LL, Dowling C, Diaz FG, Michael DB. Cerebral monitoring devices: Analysis of complications. Acta Neurochir. (Suppl)1998; 71: 47–49.
Ostrup RC, Luersssen TG, Marshall LF, Zornow MH. Continuous monitoring of intracranial pressure with a miniaturized fiberoptic device. J. Neurosurg. 1987; 67: 206–209.
The American Association of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care. Indications for intracranial pressure monitoring. J. Neurotrauma 2000; 17: 479–491.
Gibbs EL, Lennox WG, Gibbs FA. Bilateral internal jugular blood: Comparison of A-V differences, oxygen-dextrose ratios and respiratory quotients. Am. J. Psychiatry 1945; 102: 184.
Feldman Z, Robertson CS. Monitoring of cerebral hemodynamics with jugular bulb catheters. Crit. Care Clin. 1997; 13: 51–77.
Metz C, Holzschuh M, Bein T, Woertgen C, et al. Monitoring of cerebral oxygen metabolism in the jugular bulb: Reliability of unilateral measurements in severe head injury. J. Cereb. Blood Flow Metab. 1998; 18: 332–343.
Lam JMK, Chan MSY, Poon WS. Cerebral venous oxygen saturation monitoring: Is dominant jugular bulb cannulation good enough? Br. J. Neurosurg. 1996; 10: 357–364.
Robertson CS, Narayan RK, Gokaslan ZL, Pahwa R, et al. Cerebral arteriovenous oxygen difference as an estimate of cerebral blood flow in comatose patients. J. Neurosurg. 1989; 70: 222–230.
Cruz J, Miner ME, Allen SJ, Alves WM, Gennarelli TA. Continuous monitoring of cerebral oxygenation in acute brain injury: Assessment of cerebral hemodynamic reserve. Neurosurgery 1991; 29: 743–749.
Latronico N, Beindorf AE, Rasulo FA, Febbrari P, et al. Limits of intermittent jugular bulb saturation monitoring in the management of severe head trauma patients. Neurosurgery 2000; 46: 1131–1138.
Kirkpatrick PJ, Smielewski P, Czosnyka M, Menon D, Pickard JD. Near-infrared spectroscopy use in patients with head injury. J. Neurosurg. 1995; 83: 963–970.
Goetting MG, Preston G. Jugular bulb catheterization does not increase intracranial pressure. Intensive Care Med. 1991; 17: 195–198.
Browne TR, Holmes GL. Status epilepticus. In: Handbook of Epilepsy, 2nd ed. Philadelphia: Lippincott Williams Wilkins, 2000, pp. 197–214.
Young GB, Jordan KG, Doig GS. An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: An investigation of variables associated with mortality. Neurology 1996; 47: 83–89.
Wijdicks EFM. Determining brain death in adults. Neurology 1995; 45: 1003–1011.
Synek VM. Prognostically important EEG coma patterns in diffuse anoxic and traumatic encephalopathies in adults. J. Clin. Neurophysiol. 1988; 5: 161–174.
Aminoff MJ, Eisen AA. AAEM minimonograph 19: Somatosensory evoked potentials. Muscle Nerve 1998; 21: 277–290.
Diringer MN. Early prediction of outcome from coma. Curr. Opin. Neurol. Neurosurg. 1992; 5: 826.
Goldie WD, Chiappa KH, Young RR, et al. Brain stem auditory and short-latency somatosensory evoked responses in brain death. Neurology 1981; 31: 248–256.
Zandbergen EGL, de Haan RJ, Stoutenbeek CP, Koelman JHTM, Hijdra A. Systematic review of early prediction of poor outcome in anoxic-ischaemic coma. Lancet 1998; 352: 1808–1812.
Moulton RJ, Brown JIM, Konasiewicz SJ. Monitoring severe head injury: A comparison of EEG and somatosensory evoked potentials. Can. J. Neurol. Sci. 1998;25:S7–S 11.
Tegeler CH, Babikian VL, Gomez CR. Neurosonology. St. Louis: Mosby, 1996.
Manno EM. Transcranial Doppler ultrasonography in the neurocritical care unit. Crit. Care Clin. 1997; 13: 79–104.
Aaslid R, Markwalder T, Nornes H. Noninvasive transcranial Doppler ultrasound recording of flow velocities in the basal cerebral arteries. J. Neurosurg. 1982; 57: 769–774.
Jobsis FF. Noninvasive, infrared monitoring of cerebral and myocardial oxygen sufficiency and circulatory parameters. Science 1977; 198: 1264–1267.
Adelson PD, Nemoto E, Scheuer M, Painter M, et al. Noninvasive continuous monitoring of cerebral oxygenation perüctally using near-infrared spectroscopy: A preliminary report. Epilepsia 1999; 40: 1484–1489.
Witham TF, Nemoto EM, Jungreis CA, Kaufmann AM. Near-infrared spectroscopy monitored cerebral venous thrombolysis. Can. J. Neurol. Sci. 1999; 26: 48–52.
Nemoto EM, Yonas H, Kassam A. Clinical experience with cerebral oximetry in stroke and cardiac arrest. Crit. Care Med. 2000; 28: 1052–1054.
Gomersall CD, Joynt GM, Gin T, et al. Failure of the INVOS3100 cerebral oximeter to detect complete absence of cerebral blood flow. Crit. Care Med. 1997; 25: 1252–1254.
Lewis SB, Myburgh JA, Thornton EL, et al. Cerebral oxygenation monitoring by near-infrared spectroscopy is not clinically useful in patients with severe closed-head injury: A comparison with jugular venous bulb oximetry. Crit. Care Med. 1996; 24: 1334–1338.
Muellner T, Schramm W, Kwasny O, Vecsei V. Patients with increased intracranial pressure cannot be monitored using near infrared spectroscopy. Br. J. Neurosurg. 1998; 12: 136–139.
Anderson RE. Cerebral blood flow xenon-133. Neurosurg. Clin. North Am. 1996; 7: 703–708.
Martin NA, Doberstein C. Cerebral blood flow measurement in neurosurgical intensive care. Neurosurg. Clin. North Am. 1994; 5: 607–618.
Ingvar DH, Lassen NA. Quantitavie determination of cerebral blood flow in man. Lancet 1961; 2: 806–807.
Halsey JH, Nakai K, Wariyar B. Sensitivity of rCBF to focal lesion. Stroke 1981; 12: 631–635.
Arbit E, DiResta GR. Application of laser Doppler flowmetry in neurosurgery. Neurosurg. Clin. North Am. 1996; 7: 741–748.
Haberl PL, Villringer A, Dirnagl U. Applicability of laser-Doppler flowmetry for cerebral blood flow monitoring in neurological intensive care. Acta Neurochir (Suppl) 1993; 59: 64–68.
Stern MD, Lappe LD, Bowen PD, et al. Continuous measurement of tissue blood flow by laser-Doppler spectroscopy. Am. J. Physiol. 1977; 232: H441–H448.
Kirkpatrick PJ, Smielewski P, Czosnyka M, Pickard JD. Continuous monitoring of cortical perfusion by laser Doppler flowmetry in ventilated patients with head injury. J. Neurol. Neurosurg. Psych. 1994; 57: 1382–1388.
Meyerson BA, Gunasekera L, Linderoth B, Gazelius B. Bedside monitoring of regional cortical blood flow in comatose patients using laser Doppler flowmetry. Neurosurgery 1991; 29: 750–755.
Gibbs FA. A thermoelectric blood flow recorder in the form of a needle. In: Proceedings of the Society for Experimental Biology and Medicine, San Francisco 1933, pp. 141–146.
Carter LP, Weinand ME, Oommen KJ. Cerebral blood flow (CBF) monitoring in intensive care by thermal diffusion. Acta Neurochir. 1993;(Suppl)59:43–46.
Carter LP. Thermal diffusion flowmetry. Neurosurg. Clin. North Am. 1996; 7: 749–754.
Sioutos PJ, Orozco JZ, Carter LP, Weinand ME, et al. Continuous regional cerebral cortical blood flow monitoring in head-injured patients. Neurosurgery 1995; 36: 943–950.
Bolinder J, Ungerstedt U, Arner P. Long-term continuous glucose monitoring with microdialysis in ambulatory insulin-dependent diabetic patients. Lancet 1993; 342: 1080–1085.
Hutchinson PJA, O’Connell MY, Maskell LB, Pickard JD. Monitoring by subcutaneous microdialysis in neurosurgical intensive care. Acta Neurochir. (Suppl) 1999; 75: 57–59.
Nilsson OG, Brandt L, Ungerstedt U, Saveland H. Bedside detection of brain ischemia using intracerebral microdialysis: Subarachnoid hemorrhage and delayed ischemic deterioration. Neurosurgery 1999; 45: 1176–1185.
Schulz MK, Wang LP Tange M, Bjerre P. Cerebral microdialysis monitoring: determination of normal and ischemic cerebral metabolisms in patients with aneurysmal subarachnoid hemorrhage. J. Neurosurg. 2000; 93: 808–814.
Vespa P, Prins M, Ronne-Engstrom E, Caron M, et al. Increase in extracellular glutamate caused by reduced cerebral perfusion and seizures after human traumatic brain injury: a microdialysis study. J. Neurosurg. 1998; 89: 971–982.
Berger C, Annecke A, Aschoff A, et al. Neurochemical monitoring of fatal middle cerebral artery infarction. Stroke 1999; 30: 460–463.
During MJ, Spencer DD. Extracellular hippocampal glutamate and spontaneous seizure in the conscious human brain. Lancet 1993; 341: 1607–1610.
Mendelowitsch A, Sekhar LN, Wright DC, et al. An increase in intracellular glutamate is a sensitive method of detecting ischaemic neuronal damage during cranial base and cerebrovascular surgery: An in vivo microdialysis study. Acta Neurochir. 1998; 140: 349–355.
Landolt H, Langemann H, Alessandri B. A concept for the introduction of cerebral microdialysis in neurointensive care. Acta Neurochir. 1996;(Suppl)67:31–36.
Andrews RJ. Monitoring for neuroprotection: New technologies for the new millennium. Ann. NY Acad. Sci. 2000: 101–113.
van Santbrink H, Maas AIR, Avezaat CJJ. Continuous monitoring of partial pressure of brain tissue oxygen in patients with severe head injury. Neurosurgery 1996; 38: 21–31.
Kiening KL, Unterberg AW, Bardt TF, et al. Monitoring of cerebral oxygenation in patients with severe head injuries: brain tissue pO2 versus jugular vein oxygen saturation. J. Neurosurg. 1996; 85: 751–757.
van den Brink WA, van Santbrink H, Steyerberg EW, et al. Brain oxygen tension in severe head injury. Neurosurgery 2000; 46: 868–878.
Valadka AB, Shankar SP, Contant CF, et al. Relationship of brain tissue pO2 to outcome after severe head injury. Crit. Care Med. 1998; 26: 1576–1581.
Alvarez del Castillo M. Monitoring neurologic patients in intensive care. Curr. Opin. Crit. Care 2001; 7: 49–60.
Hoffman WE, Wheeler P, Edelman G. Hypoxic brain tissue following subarachnoid hemorrhage. Anesthesiology 2000; 92: 442–446.
Zimmerman JL, Dellinger RP. Blood gas monitoring. Crit. Care Clin. 1996; 12: 865–874.
Giuliano KK, Giuliano AJ, Scott SS, et al. Temperature measurement in critically ill adults: a comparison of tympanic and oral methods. Am. J. Crit. Care 2000; 9: 254–261.
Fallis WM. Oral measurement of temperature in orally intubated critical care patients: state-of-the-science review. Am. J. Crit. Care 2000; 9: 334–343.
Kirkpatrick PJ, Czosnyka M, Pickard JD. Multimodal monitoring in neurointensive care. J. Neurol. Neurosurg. Psychiatry 1996; 60: 131–139.
Khan SH, Kureshi IU, Mulgrew T, et al. Comparison of percutaneous ventriculostomies and intraparenchymal monitor: A retrospective evaluation of 156 patients. Acta Neurochir. (Suppl) 1998; 71: 50–52.
Sheinberg M, Kanter MJ, Robertson CS, et al. Continuous monitoring of jugular venous oxygen saturation in head-injured patients. J. Neurosurg. 1992; 76: 212–217.
Hassler W, Steinmetz H, Gawlowski J. Transcranial Doppler ultrasonography in raised intracranial pressure and in intracranial circulatory arrest. J. Neurosurg. 1988; 68: 745–751.
Wardlaw JM, Offin R, Teasdale GM, et al. Is routine transcranial Doppler ultrasound monitoring useful in the management of subarachnoid hemorrhage? J. Neurosurg. 1998; 88: 272–276.
Brass LM, Pavlakis SG, DeVivo D, et al. Transcranial Doppler measurements of the middle cerebral artery: Effect of hematocrit. Stroke 1988; 19: 1466–1469.
Recommendations for intracranial pressure monitoring technology. J. Neurotrauma 2000; 17: 497–505.
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Miller, D.W., Suarez, J.I. (2004). Neurologic and Systemic Monitoring in the NSU. In: Suarez, J.I. (eds) Critical Care Neurology and Neurosurgery. Current Clinical Neurology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-660-7_6
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DOI: https://doi.org/10.1007/978-1-59259-660-7_6
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