Neuromonitoring

Management of acute brain injury is based on a central concept that prevention of secondary hypoxic/ischaemic injury is associated with improved outcomes. While clinical assessment of neurological state remains fundamental to neuromonitoring, several techniques are available for global and regional brain monitoring that provide assessment of cerebral perfusion, oxygenation and metabolic status, and early warning of impending brain hypoxia/ischaemia. Developments in multimodality monitoring has enabled an individually tailored approach to patient management in which treatment decisions are guided by monitored changes in physiological variables rather than pre-defined, generic thresholds. Any impact of monitor-guided therapy on outcomes is entirely dependent on the threshold to initiate intervention and subsequent management in response to change in a particular monitored variable, and these remain undefined in many circumstances, without significant evidence of efficacy. This article describes current neuromonitoring techniques used during the critical care management of acute brain injury and explore the current evidence for their use.