Multimodal Cerebral Monitoring in Comatose Head-Injured Patients

Abstract

Monitoring of comatose patients in the neurosurgical intensive care unit (NICU) is constantly extended by the development of new methods for monitoring of cerebral function, metabolism and oxygenation. To simplify the interpretation of the rising number of parameters, and to avoid data overflow, a multimodal cerebral monitoring (MCM) system has been developed for the acquisition, display, on-line analysis and recording of physiological parameters from multiple bedside data sources. This article describes the technical details and the design of this computerized data acquisition system for variable applications in clinical patient monitoring and research. A Windows (Microsoft Corporation, Redmont, Washington) platform was equipped with an analog/digital converter board. Software for multimodal cerebral monitoring was developed using LabVIEW for Windows (National Instruments, Austin, Texas), a graphical programming system. Two software modules were created: One for the automatic acquisition of data, display of time dependent trend graphs, processing of on-line histograms, special functions for research, and storage of data in compatible format. The other module serves as an off-line monitor to display recorded data in various modalities. The MCM system has been used in 30 comatose patients with severe head injury. Mean time of MCM is 5.3 days (+/- 2.8 days), resulting in a total running time of the system of about 3800 hrs. Hardware and software proved to run stable and safe. The MCM system has become a valuable tool for monitoring of comatose patients. The simultaneous display of trend graphs of various monitoring parameters and the online processing of histograms improved the survey of the patient's condition in the ICU. Recorded data were analysed offline and contribute to a consecutively increasing data bank.

Intracranial Multimodal Monitoring for Acute Brain Injury: A Single Institution Review of Current Practices

“…Major advances have been made in the critical care management of patients with severe acute brain injury such as intracerebral hemorrhage (ICH), traumatic brain injury (TBI), ischemic stroke, status epilepticus, and subarachnoid hemorrhage (SAH) [1][2][3][4][5][6][7][8][9][10]. Many patients with catastrophic neurological brain injury are comatose and unresponsive which severely limits the ability of the neurological examination to detect secondary complications such as ICP crises, ischemia from vasospasm, or electrographic seizures.…”

“…Results Monitored modalities included brain tissue oxygen (PbtO 2 ) in 97% (N = 59), microdialysis (MD) in 79% (N = 48), intracranial electroencephalography in 31% (N = 19), brain temperature in 18% (N = 11), and cerebral blood flow in 11% (N = 7). On average, monitoring started within 2 days (0-8) of admission and was continued for 7 days (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). The majority of probes (56%; N = 35) were placed into patients with focal brain injuries, while in 43% N = 26 the injury was diffuse.…”

Multimodal monitoring in the ICU: When could it be useful?

“…The high frequency of mechanical alarms being generated by some systems resulted in nurses turning the alarms off in one report. Perhaps most importantly, the massive volume of data can become overwhelming, making it difficult for clinicians to consider all the data in an expeditious but thoughtful manner, possibly negating the positive effects of monitoring [34].…”

“…Due to the large amount of data generated, computer supported data analysis and archiving are required for true multimodal monitoring [27]. Such equipment is expensive to invest in and maintain, and such maintenance is time-consuming [34]. Furthermore, members of the health care team need to be trained to insert the newer catheters and use the monitoring systems.…”

Current Concepts in Diagnosis and Treatment of Traumatic Brain Injury: Implications for Healthcare in Nepal

“…Detailed retrospective analyses with higher transparency become possible. 3 The first experiences in this field have shown that this is not a trivial challenge and multimodal cerebral monitoring is continuously developing. In Europe, a multicenter initiative has recently been founded by experts in the field ("Brain IT", www.brainit.org).…”