Monitoring of Brain Function in Neurointensive Care: Current State and Future Requirements

Chapter

Abstract

Although the human brain comprises only 2% of the body weight, it receives 15–20% of the cardiac output and accounts for 20% of the total body oxygen consumption. Since the brain has almost no energy reserves, adequate cerebral blood flow is essential to prevent brain damage. Under normal circumstances the brain has an intrinsic ability to regulate its blood supply. This cerebral autoregulation may be impaired after traumatic brain injury or other cerebral insults (e.g. subarachnoid haemorrhage). For the treating neurointensivist, it is one of the main therapeutic needs to maintain adequate cerebral perfusion in these patients to prevent secondary brain insults, which ultimately result in further cerebral damages. Up to now, there are only few monitoring tools available to achieve this goal. All of them have limitations (e.g. focal methods with a sampling error, exposure to radiation, no 24 h availability, high staff resources, high costs). This chapter will give an overview about the current monitoring strategies and the requirements new techniques have to fulfil.

References

  1. 1.
    Becker, G., Bogdahn, U., Strassburg, H.M., Lindner, A., Hassel, W., Meixensberger, J., Hofmann, E.: Identification of ventricular enlargement and estimation of intracranial pressure by transcranial color-coded real-time sonography. J. Neuroimaging 4(1), 17–22 (1994)CrossRefGoogle Scholar
  2. 2.
    Bolesch, S., von Wegner, F., Senft, C., Lorenz, M.W.: Transcranial ultrasound to detect elevated intracranial pressure: comparison of septum pellucidum undulations and optic nerve sheath diameter. Ultrasound Med. Biol. 41(5), 1233–1240 (2015)CrossRefGoogle Scholar
  3. 3.
    Citerio, G., Oddo, M., Taccone, F.S.: Recommendations for the use of multimodal monitoring in the neurointensive care unit. Curr. Opin. Crit. Care 21, 113–119 (2015)CrossRefGoogle Scholar
  4. 4.
    Oddo, M., Villa, F., Citerio, G.: Brain multimodality monitoring: an update. Curr. Opin. Crit. Care 18, 111–118 (2012)CrossRefGoogle Scholar
  5. 5.
    Reitmeir, R., Eyding, J., Oertel, M.F., Wiest, R., Gralla, J., Fischer, U., Giquel, P.Y., Weber, S., Raabe, A., Mattle, H.P., Z’Graggen, W.J., Beck, J.: Is ultrasound perfusion imaging capable of detecting mismatch? A proof-of-concept study in acute stroke patients. J. Cereb. Blood Flow 37, 1517–1526 (2016)CrossRefGoogle Scholar
  6. 6.
    Rossetti, A.O., Rabinstein, A.A., Oddo, M.: Neurological prognostication of outcome in patients in coma after cardiac arrest. Lancet Neurol. 15, 597–609 (2016)CrossRefGoogle Scholar
  7. 7.
    Siesjö, B.K.: Cerebral circulation and metabolism. J. Neurosurg. 60(5), 883–908 (1984)CrossRefGoogle Scholar
  8. 8.
    Torbey, M., Bhardwaj, A.: Cerebral blood flow physiology and monitoring. In: Suarez, J.L. (ed.) Critical Care Neurology and Neurosurgery, pp. 23–36. Humana Press, Totowa (2004)CrossRefGoogle Scholar
  9. 9.
    Ulrich, C.T., Fung, C., Vatter, H., et al.: Occurrence of vasospasm and infarction in relation to a focal monitoring sensor in patients after SAH: placing a bet when placing a probe? PLoS ONE 8, e62754 (2013)CrossRefGoogle Scholar
  10. 10.
    Waydhas, C.: Intrahospital transport of critically ill patients. Crit. Care 3, R83–R89 (1999)CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryInselspital, Bern University Hospital, University of BernBernSwitzerland

Personalised recommendations