Current state of high-fidelity multimodal monitoring in traumatic brain injury
INTRODUCTION: Multimodality monitoring of patients with severe traumatic brain injury (TBI) is primarily performed in neuro-critical care units to prevent secondary harmful brain insults and facilitate patient recovery. Several metrics are commonly monitored using both invasive and non-invasive tech...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Vienna
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9705453/ https://www.ncbi.nlm.nih.gov/pubmed/36260235 http://dx.doi.org/10.1007/s00701-022-05383-8 |
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author | Lindblad, Caroline Raj, Rahul Zeiler, Frederick A. Thelin, Eric P. |
author_facet | Lindblad, Caroline Raj, Rahul Zeiler, Frederick A. Thelin, Eric P. |
author_sort | Lindblad, Caroline |
collection | PubMed |
description | INTRODUCTION: Multimodality monitoring of patients with severe traumatic brain injury (TBI) is primarily performed in neuro-critical care units to prevent secondary harmful brain insults and facilitate patient recovery. Several metrics are commonly monitored using both invasive and non-invasive techniques. The latest Brain Trauma Foundation guidelines from 2016 provide recommendations and thresholds for some of these. Still, high-level evidence for several metrics and thresholds is lacking. METHODS: Regarding invasive brain monitoring, intracranial pressure (ICP) forms the cornerstone, and pressures above 22 mmHg should be avoided. From ICP, cerebral perfusion pressure (CPP) (mean arterial pressure (MAP)–ICP) and pressure reactivity index (PRx) (a correlation between slow waves MAP and ICP as a surrogate for cerebrovascular reactivity) may be derived. In terms of regional monitoring, partial brain tissue oxygen pressure (PbtO(2)) is commonly used, and phase 3 studies are currently ongoing to determine its added effect to outcome together with ICP monitoring. Cerebral microdialysis (CMD) is another regional invasive modality to measure substances in the brain extracellular fluid. International consortiums have suggested thresholds and management strategies, in spite of lacking high-level evidence. Although invasive monitoring is generally safe, iatrogenic hemorrhages are reported in about 10% of cases, but these probably do not significantly affect long-term outcome. Non-invasive monitoring is relatively recent in the field of TBI care, and research is usually from single-center retrospective experiences. Near-infrared spectrometry (NIRS) measuring regional tissue saturation has been shown to be associated with outcome. Transcranial doppler (TCD) has several tentative utilities in TBI like measuring ICP and detecting vasospasm. Furthermore, serial sampling of biomarkers of brain injury in the blood can be used to detect secondary brain injury development. CONCLUSIONS: In multimodal monitoring, the most important aspect is data interpretation, which requires knowledge of each metric’s strengths and limitations. Combinations of several modalities might make it possible to discern specific pathologic states suitable for treatment. However, the cost–benefit should be considered as the incremental benefit of adding several metrics has a low level of evidence, thus warranting additional research. |
format | Online Article Text |
id | pubmed-9705453 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer Vienna |
record_format | MEDLINE/PubMed |
spelling | pubmed-97054532022-11-30 Current state of high-fidelity multimodal monitoring in traumatic brain injury Lindblad, Caroline Raj, Rahul Zeiler, Frederick A. Thelin, Eric P. Acta Neurochir (Wien) Mini-review (by Invitation) - Brain trauma INTRODUCTION: Multimodality monitoring of patients with severe traumatic brain injury (TBI) is primarily performed in neuro-critical care units to prevent secondary harmful brain insults and facilitate patient recovery. Several metrics are commonly monitored using both invasive and non-invasive techniques. The latest Brain Trauma Foundation guidelines from 2016 provide recommendations and thresholds for some of these. Still, high-level evidence for several metrics and thresholds is lacking. METHODS: Regarding invasive brain monitoring, intracranial pressure (ICP) forms the cornerstone, and pressures above 22 mmHg should be avoided. From ICP, cerebral perfusion pressure (CPP) (mean arterial pressure (MAP)–ICP) and pressure reactivity index (PRx) (a correlation between slow waves MAP and ICP as a surrogate for cerebrovascular reactivity) may be derived. In terms of regional monitoring, partial brain tissue oxygen pressure (PbtO(2)) is commonly used, and phase 3 studies are currently ongoing to determine its added effect to outcome together with ICP monitoring. Cerebral microdialysis (CMD) is another regional invasive modality to measure substances in the brain extracellular fluid. International consortiums have suggested thresholds and management strategies, in spite of lacking high-level evidence. Although invasive monitoring is generally safe, iatrogenic hemorrhages are reported in about 10% of cases, but these probably do not significantly affect long-term outcome. Non-invasive monitoring is relatively recent in the field of TBI care, and research is usually from single-center retrospective experiences. Near-infrared spectrometry (NIRS) measuring regional tissue saturation has been shown to be associated with outcome. Transcranial doppler (TCD) has several tentative utilities in TBI like measuring ICP and detecting vasospasm. Furthermore, serial sampling of biomarkers of brain injury in the blood can be used to detect secondary brain injury development. CONCLUSIONS: In multimodal monitoring, the most important aspect is data interpretation, which requires knowledge of each metric’s strengths and limitations. Combinations of several modalities might make it possible to discern specific pathologic states suitable for treatment. However, the cost–benefit should be considered as the incremental benefit of adding several metrics has a low level of evidence, thus warranting additional research. Springer Vienna 2022-10-19 2022 /pmc/articles/PMC9705453/ /pubmed/36260235 http://dx.doi.org/10.1007/s00701-022-05383-8 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Mini-review (by Invitation) - Brain trauma Lindblad, Caroline Raj, Rahul Zeiler, Frederick A. Thelin, Eric P. Current state of high-fidelity multimodal monitoring in traumatic brain injury |
title | Current state of high-fidelity multimodal monitoring in traumatic brain injury |
title_full | Current state of high-fidelity multimodal monitoring in traumatic brain injury |
title_fullStr | Current state of high-fidelity multimodal monitoring in traumatic brain injury |
title_full_unstemmed | Current state of high-fidelity multimodal monitoring in traumatic brain injury |
title_short | Current state of high-fidelity multimodal monitoring in traumatic brain injury |
title_sort | current state of high-fidelity multimodal monitoring in traumatic brain injury |
topic | Mini-review (by Invitation) - Brain trauma |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9705453/ https://www.ncbi.nlm.nih.gov/pubmed/36260235 http://dx.doi.org/10.1007/s00701-022-05383-8 |
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