Multimodal neuromonitoring for traumatic brain injury management [Neurosurgery Wiki]

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====== Multimodal neuromonitoring for traumatic brain injury management ======


{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1RYYbE7j9SU3Be0THngBL4ELVftm0WYo7D2KOUjoOrE19aDUOh/?limit=15&utm_campaign=pubmed-2&fc=20250401190021}}


[[Multimodal neuromonitoring]] for [[traumatic brain injury management]] is primarily performed in [[neurointensive care]] [[unit]]s to prevent secondary harmful brain insults and facilitate patient recovery. Several metrics are commonly monitored using both invasive and non-invasive techniques. The [[Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition]] from [[2016]] provides [[recommendation]]s and [[threshold]]s for some of these. Still, high-level [[evidence]] for several metrics and thresholds is lacking.

Methods: Regarding invasive brain monitoring, intracranial pressure (ICP) forms the cornerstone, and pressures above 22 mmHg should be avoided. From ICP, cerebral perfusion pressure (CPP) (mean arterial pressure (MAP)-ICP) and pressure reactivity index (PRx) (a correlation between slow waves MAP and ICP as a surrogate for cerebrovascular reactivity) may be derived. In terms of regional monitoring, partial brain tissue oxygen pressure (PbtO2) is commonly used, and phase 3 studies are currently ongoing to determine its added effect to outcome together with ICP monitoring. Cerebral microdialysis (CMD) is another regional invasive modality to measure substances in the brain extracellular fluid. International consortiums have suggested thresholds and management strategies, in spite of lacking high-level evidence. Although invasive monitoring is generally safe, iatrogenic hemorrhages are reported in about 10% of cases, but these probably do not significantly affect long-term outcome. Non-invasive monitoring is relatively recent in the field of TBI care, and research is usually from single-center retrospective experiences. Near-infrared spectrometry (NIRS) measuring regional tissue saturation has been shown to be associated with outcome. Transcranial doppler (TCD) has several tentative utilities in TBI like measuring ICP and detecting vasospasm. Furthermore, serial sampling of biomarkers of brain injury in the blood can be used to detect secondary brain injury development.

In [[multimodal monitoring]], the most important aspect is data [[interpretation]], which requires knowledge of each metric's strengths and limitations. Combinations of several modalities might make it possible to discern specific pathologic states suitable for treatment. However, the cost-benefit should be considered as the incremental benefit of adding several metrics has a low level of evidence, thus warranting additional research
((Lindblad C, Raj R, Zeiler FA, Thelin EP. Current state of high-fidelity multimodal monitoring in traumatic brain injury. Acta Neurochir (Wien). 2022 Oct 19. doi: 10.1007/s00701-022-05383-8. Epub ahead of print. PMID: 36260235.)).

===== Reviews =====

Bögli et al. aimed to provide clinicians, researchers, and [[healthcare]] [[professional]]s with detailed, compelling [[example]]s of potential [[application]]s of multimodality neuromonitoring, focused on high-resolution modalities within the field of [[traumatic brain injury]]. This [[case series]] showcases how [[neuromonitoring techniques]] such as [[intracranial pressure]], [[brain tissue oxygenation]], [[near-infrared spectroscopy]], and [[transcranial Doppler]] can be integrated with [[cerebral microdialysis]], [[neuroimaging]], and systemic physiology monitoring. The aim is to demonstrate the value of a [[multimodal]] approach based on high-resolution data and derived indices integrated in one monitoring tool. This allows for improving the diagnosis, monitoring, and treatment of patients with [[traumatic brain injury]]. For this purpose, key concepts are covered, and various cases have been described to illustrate how to make the most of this advanced [[monitoring]] [[technology]]
((Bögli SY, Beqiri E, Olakorede I, Cherchi MS, Smith CA, Chen X, Di Tommaso G, Rochat T, Tanaka Gutiez M, Cucciolini G, Motroni V, Helmy A, Hutchinson P, Lavinio A, Newcombe VFJ, Smielewski P. Unlocking the potential of high-resolution multimodality neuromonitoring for traumatic brain injury management: lessons and insights from cases, events, and patterns. Crit Care. 2025 Mar 31;29(1):139. doi: 10.1186/s13054-025-05360-4. PMID: 40165332.)).