Integrated Approaches to Multimodality Monitoring of Cerebral Physiology

Delayed secondary brain injury occurs in the hours, days, and weeks after acute brain insults and can markedly worsen neurologic outcomes. A multitude of pathophysiological processes, both systemic and neurologic, can trigger secondary brain injury. Physiological monitoring at the bedside can help identify these processes in real time so that therapies that potentially reduce the burden of secondary injury can be deployed. Multimodality monitoring (MMM) refers to any strategy where multiple indices of brain and systemic physiology are simultaneously and continuously monitored. While MMM may allow for a more nuanced picture of brain function during critical illness, it produces a plethora of data that can be confusing to interpret. This chapter will provide a systematic approach for MMM data interpretation during the clinical care of a critically ill, brain-injured patient.