title: Multimodal neuromonitoring for traumatic brain injury: A shift towards individualized therapy.
abstract: Multimodal neuromonitoring in the management of traumatic brain injury (TBI) enables clinicians to make individualized management decisions to prevent secondary ischemic brain injury. Traditionally, neuromonitoring in TBI patients has consisted of a combination of clinical examination, neuroimaging and intracranial pressure monitoring. Unfortunately, each of these modalities has its limitations and although pragmatic, this simplistic approach has failed to demonstrate improved outcomes, likely owing to an inability to consider the underlying heterogeneity of various injury patterns. As neurocritical care has evolved, so has our understanding of underlying disease pathophysiology and patient specific considerations. Recent additions to the multimodal neuromonitoring platform include measures of cerebrovascular autoregulation, brain tissue oxygenation, microdialysis and continuous electroencephalography. The implementation of neurocritical care teams to manage patients with advanced brain injury has led to improved outcomes. Herein, we present a narrative review of the recent advances in multimodal neuromonitoring and highlight the utility of dedicated neurocritical care.
authors.affiliation: Division of Neurosurgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Serge
authors.initials: S
authors.lastname: Makarenko
authors.affiliation: Department of Anaesthesiology, Pharmacology and Therapeutics, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada; Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, Room 2438, Jim Pattison Pavilion, 2nd Floor, 899 West 12th Avenue, University of British Columbia, Vancouver, BC V5Z 1M9, Canada.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Griesdale
authors.affiliation: Division of Neurosurgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Gooderham
authors.affiliation: Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, Room 2438, Jim Pattison Pavilion, 2nd Floor, 899 West 12th Avenue, University of British Columbia, Vancouver, BC V5Z 1M9, Canada. Electronic address: mypinder.sekhon2@vch.ca.
authors.forename: Mypinder S
authors.initials: MS
authors.lastname: Sekhon
mesh_terms: D001921:Brain / Q000503:physiopathology*; D001930:Brain Injuries / Q000175:diagnosis* / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D003422:Critical Care; D004569:Electroencephalography; D006706:Homeostasis; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology*; D008991:Monitoring, Physiologic / Q000379:methods*; D064847:Multimodal Imaging; D059906:Neuroimaging; D057285:Precision Medicine
keywords: Brain tissue oxygenation; Intracranial pressure; Multimodal monitoring; Pressure reactivity index