Use of multimodality neuromonitoring in the management of traumatic brain injury

Multimodality neuromonitoring has become an essential part of neurocritical care over the past several decades. Until the 1980s, electronic monitoring in the intensive care unit (ICU) was limited to typical cardiopulmonary vital signs to augment the neurologic examination and older techniques of monitoring intracranial pressure (ICP) via cerebrospinal fluid (CSF) drainage and fluidcoupled mechanisms. Prior to this, clinicians did not have the consistent ability to directly measure and manage physiologic parameters specific to the nervous system. The first brain-specific physiologic monitoring technology to emerge was intracranial pressure. Beginning in the 1980s, ICP parenchymal monitoring became available, and the technique became widespread in the United States. Monitoring was used to study the impact of ICP on outcome and with the clinical goal of reducing intracranial pressure to prevent secondary neurologic injury. Imputed cerebral perfusion pressure (CPP) values were now possible to obtain in continuous fashion, and attention was also placed on identifying optimal CPP to reduce secondary injury, which was the focus of a good deal of research in the 1990s. Since that time, cerebral monitoring has become more common as well as more diverse. Physiologic parameters that can now be measured include cerebral blood flow (CBF), partial pressure of oxygen in brain tissue or oxygen saturation (pBtO2), brain temperature, and various measures of cerebral metabolism via microdialysis.