Integration of Brain Oxygen Measurement and Cerebral Metabolism: Brain Tissue Oxygenation, Jugular Bulb Oximetry, Intracerebral Microdialysis and Brain Neuromarkers

Intensive care physicians must recognise that TBI is not a homogeneous syndrome. Don’t recognise the variances, improperly using monitoring, letting therapy be guided by monitoring rather than by pattern and patient’s problems can be associated with iatrogenic complication. A fundamental aspect of neuromonitoring selection is the availability of economic and human resources suitable for implementing the monitoring and its constant interpretation. An additional aspect to consider is the evidence of the efficacy of neuromonitoring as their ability to identify potentially harmful phenomena and, as a further step, that therapies could improve the physiopathologically altered target without introducing additional costs for global patient health. Over the 30 years in which the bedside tools SjO2, PbtO2, and cerebral microdialysis have spread, they have represented the willingness of high- income countries to combat secondary damage. Although physicians expect these interventions could reduce the biological damage and ultimately improve functional outcome, these benefits have not been definitively proved even in well-conducted research. However, the overall outcome of TBI patients slowly improves, probably due to the indirect teachings from different monitoring techniques. For example, paying more attention to blood pressure, natremia, temperature control, and management of PaCO2 which can significantly afflict the penumbra.