Recommendations for the use of multimodal monitoring in the neurointensive care unit

Citerio, Giuseppe; Oddo, Mauro; Taccone, Fabio Silvio

doi:10.1097/mcc.0000000000000179

Cited by 61 publications

(65 citation statements)

References 65 publications

(58 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Outcome (eGOS) at six months was available in 28 patients. The median outcome was poor (3 [1,6]), and 13 of the 28 patients died. Figure 3 shows the time courses of the TDDDs, mean baseline p ti O 2 , mean baseline CPP, mean baseline MAP, mean baseline ICP, and mean baseline brain temperature over the first 11 days after the initial hemorrhage.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Oxygen availability and spreading depolarizations provide complementary prognostic information in neuromonitoring of aneurysmal subarachnoid hemorrhage patients

Winkler

Dengler

Hecht

et al. 2016

J Cereb Blood Flow Metab

View full text Add to dashboard Cite

Multimodal neuromonitoring in neurocritical care increasingly includes electrocorticography to measure epileptic events and spreading depolarizations. Spreading depolarization causes spreading depression of activity (=isoelectricity) in electrically active tissue. If the depression is long-lasting, further spreading depolarizations occur in still isoelectric tissue where no activity can be suppressed. Such spreading depolarizations are termed isoelectric and are assumed to indicate energy compromise. However, experimental and clinical recordings suggest that long-lasting spreading depolarization-induced depression and isoelectric spreading depolarizations are often recorded outside of the actual ischemic zones, allowing the remote diagnosis of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Here, we analyzed simultaneous electrocorticography and tissue partial pressure of oxygen recording in 33 aneurysmal subarachnoid hemorrhage patients. Multiple regression showed that both peak total depression duration per recording day and mean baseline tissue partial pressure of oxygen were independent predictors of outcome. Moreover, tissue partial pressure of oxygen preceding spreading depolarization was similar and differences in tissue partial pressure of oxygen responses to spreading depolarization were only subtle between isoelectric spreading depolarizations and spreading depressions. This further supports that, similar to clustering of spreading depolarizations, long spreading depolarization-induced periods of isoelectricity are useful to detect energy compromise remotely, which is valuable because the exact location of future developing pathology is unknown at the time when the neurosurgeon implants recording devices.

show abstract

Section: Resultsmentioning

confidence: 99%

“…1 The most widely used measures are currently intracranial pressure (ICP), brain perfusion, brain oxygen availability (measured as tissue partial pressure of oxygen [p ti O 2 ]) and scalp electroencephalography (EEG) or, respectively, invasive electrocorticography (ECoG).…”

Section: Introductionmentioning

confidence: 99%

Oxygen availability and spreading depolarizations provide complementary prognostic information in neuromonitoring of aneurysmal subarachnoid hemorrhage patients

Winkler

Dengler

Hecht

et al. 2016

J Cereb Blood Flow Metab

View full text Add to dashboard Cite

show abstract

“…Several studies have shown variable levels for management of neuronal trauma. Our survey shows that the EVD is the preferred technique for ICP monitoring in patients with traumatic brain injury (16)(17)(18)(19)(20)(21). We found that using techniques such as Ghajar Guide is infrequent, perhaps because of the high cost of this system in a country with limited resources such as Colombia.…”

Section: Discussionmentioning

confidence: 90%

A Colombian-based survey on ventriculostomy and intracranial pressure monitor placement practices

Salazar¹,

Rubiano

Miranda

et al. 2016

Journal of Emergency Practice and Trauma

View full text Add to dashboard Cite

ResultsFifty-one neurosurgeons completed the survey, all neurosurgeons worked in Colombia. The majority of the respondents had more than 10 years of experience (68.6%; n = 35), ≤5 years (13.7%; n = 7), 5-10 years (17.6%; n = 9). When asked about occupation, 51 (100%) were active Abstract Objective: Monitoring of intracranial pressure (ICP) is a routine procedure in the neurosurgery field. Although the routine practice of monitoring ICP has decreased in recent years, the practice patterns have not been studied in Colombia. This study was designed to evaluate the current practice for ventriculostomy and ICP monitoring by neurosurgeons in Colombia. Methods: An 11-question electronic survey was delivered to 380 practicing neurosurgeons. Demographic information and rates of proper ventriculostomy placement for monitoring of ICP were described. Results: Fifty-one percent of practicing neurosurgeons responded to the survey (response rate 13.4%). The rate of successful cannulation of the ipsilateral ventricle ranged from 70% to 100%. Conclusion: This survey shows that Colombian neurosurgeons have similar tendencies to other developed countries. Prospective studies are necessary to establish actual evidencebased practices. Short Communication

show abstract

“…Sophisticated haemodynamic monitoring systems are involved, including mechanisms of data acquisition and analysis. Needless to say, the challenge will be the real-time interpretation and integration into individualised targeted therapy regimens 65. However, it is important to highlight that despite over 10 years of use in neurocritical intensive care, robust evidence on how to better integrate multimodal monitoring-derived information at the bedside to improve patient management is lacking.…”

Section: Multimodal Monitoring and Decision Support Systemsmentioning

confidence: 99%

Objective cardiovascular assessment in the neonatal intensive care unit

Dempsey

El-Khuffash²

2017

Arch Dis Child Fetal Neonatal Ed

View full text Add to dashboard Cite

Traditionally, cardiovascular well-being was essentially based on whether the mean blood pressure was above or below a certain value. However, this singular crude method of assessment provides limited insight into overall cardiovascular well-being. Echocardiography has become increasingly used and incorporated into clinical care. New objective modality assessments of cardiovascular status continue to evolve and are being evaluated and incorporated into clinical care. In this review article, we will discuss some of the recent advances in objective assessment of cardiovascular well-being, including the concept of multimodal monitoring. Sophisticated haemodynamic monitoring systems are being developed, including mechanisms of data acquisition and analysis. Their incorporation into clinical care represents an exciting next stage in the management of the infant with cardiovascular compromise.

show abstract

Recommendations for the use of multimodal monitoring in the neurointensive care unit

Cited by 61 publications

References 65 publications

Oxygen availability and spreading depolarizations provide complementary prognostic information in neuromonitoring of aneurysmal subarachnoid hemorrhage patients

Oxygen availability and spreading depolarizations provide complementary prognostic information in neuromonitoring of aneurysmal subarachnoid hemorrhage patients

A Colombian-based survey on ventriculostomy and intracranial pressure monitor placement practices

Objective cardiovascular assessment in the neonatal intensive care unit

Contact Info

Product

Resources

About