Multi-modal monitoring of acute brain injury.
OBJECTIVE
To review the scientific basis for and utility of the traditional cerebral monitors used currently in neurointensive care, together with research techniques that are soon likely to become used in managing severe head injury and subarachnoid haemorrhage.
Firstly, the pathophysiology of acute brain injury including cerebral haemodynamics, oxygen and metabolism and the role of secondary insults are discussed. Secondly, the importance of assessment of cerebrovascular autoregulation and reactivity is reviewed together with methods for its continuous non-invasive measurement using transcranial Doppler and intracranial pressure/arterial pressure recordings. Thirdly, the respective roles of jugular venous oxygen and brain tissue oxygen monitoring are analysed. Fourthly, the use of cerebral microdialysis is described, together with an overview of its utility.


CONCLUSIONS
Cerebral multimodal monitoring can be helpful for the optimal management of acute brain injury and essential for future exploratory trials of neuroprotective drugs.
Kett-White
R
R
Academic Neurosurgical Unit and the Wolfson Brain Imaging Centre, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
Hutchinson
P J
PJ
Czosnyka
M
M
Boniface
S
S
Pickard
J D
JD
Kirkpatrick
P J
PJ
D000208:Acute Disease; D000818:Animals; D001921:Brain / Q000378:metabolism; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D017551:Microdialysis; D008991:Monitoring, Physiologic / Q000379:methods*; D010092:Oximetry; D017585:Ultrasonography, Doppler, Transcranial