Invasive Neurological and Multimodality Monitoring in the Neuro-ICU

Patients admitted to the neurocritical care unit (NCCU) are at risk for secondary brain injury that frequently can exacerbate outcomes. Consequently, current NCCU management strategies focus on the identification, prevention, and management of secondary brain injury since there are few pharmacological agents that demonstrate efficacy in these patients. In the last decade, techniques to monitor brain function have evolved and, in the modern NCCU, play an important role in patient care and, in particular, in a patient-specific targeted approach. Monitors include radiologic techniques that provide information about a specific point in time or bedside monitors that provide continuous or noncontinuous physiologic information. In turn, these bedside techniques may be subdivided into invasive or noninvasive monitors. In this review, we will discuss invasive intracranial monitors, including (1) intracranial pressure; (2) monitors of cerebral oxygenation (direct measurement of brain oxygen [PbtO2] and jugular venous catheters); (3) metabolic monitors, i.e., cerebral microdialysis; (4) cerebral blood flow monitors such as thermal diffusion flowmetry and laser Doppler flowmetry; (5) invasive electroencephalography.