Exploring Trends in Neuromonitoring Use in a General Pediatric ICU: The Need for Standardized Guidance

Abstract

Neuromonitoring has become more standardized in adult neurocritical care, but the utility of different neuromonitoring modalities in children remains debated. We aimed to describe the use of neuromonitoring in critically ill children with and without primary neurological diseases. We conducted a retrospective review of patients admitted to a 32-bed, non-cardiac PICU during a 12-month period. Neuro-imaging, electroencephalogram (EEG), cerebral oximetry (NIRS), automated pupillometry, transcranial doppler (TCD), intracranial pressure (ICP) monitoring, brain tissue oxygenation (PbtO2), primary diagnosis, and outcome were extracted. Neuromonitoring use by primary diagnosis and associations with outcome were observed. Of 1946 patients, 420 received neuro-imaging or neuromonitoring. Primary non-neurological diagnoses most frequently receiving neuromonitoring were respiratory, hematologic/oncologic, gastrointestinal/liver, and infectious/inflammatory. The most frequently used technologies among non-neurological diagnoses were neuro-imaging, EEG, pupillometry, and NIRS. In the multivariate analysis, pupillometry use was associated with mortality, and EEG, NIRS, and neuro-imaging use were associated with disability. Frequencies of TCD and PbtO2 use were too small for analysis. Neuromonitoring is prevalent among various diagnoses in the PICU, without clear benefit on outcomes when used in an ad hoc fashion. We need standard guidance around who, when, and how neuromonitoring should be applied to improve the care of critically ill children.

Survey of Pediatric ICU EEG Monitoring–Reassessment After a Decade

“…33,34 These findings are consistent with surveys addressing adult ICU CEEG monitoring 26,27,30 and observational data of PICU patients undergoing CEEG. 35…”

Sustainability of a Pediatric Neurointensive Care Unit Model Within a Mixed Pediatric Intensive Care Unit and Its Effect on Nursing Sentiment

“…Around 30% of our PICU consists of patients who have primary PNCC diagnoses or who develop secondary neurological insults. 13 In this setting, on June 1, 2020, six neighboring beds were designated for the neuro-PICU embedded within the upper-level PICU. Beds were chosen for their distance from front door noise, proximity to operating room and radiology elevators, and proximity to the acute care neuroscience ward (Supplemental Fig 1, http://links.lww.com/JNN/ A517).…”

Approaches to neuroprotection in pediatric neurocritical care

“…Patients with acute brain injuries typically warrant additional neurophysiologic monitoring. This includes ICP monitoring using an external ventricular drain or intraparenchymal monitor, intraparenchymal brain tissue oxygenation, regional oxygen saturation via near infrared spectroscopy, cEEG, pupillometry, or information on CBF provided by various imaging techniques including transcranial doppler and thermal diffusion flowmetry[ 81 , 82 ]. Until recently, this information was typically evaluated in isolation or in small subsets.…”