Monitoring of head injured patients

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Abstract

Purpose of review

This article reviews recent advances in multimodality monitoring of patients following severe head injury during the period of 2004–2005.

Recent findings

Whilst intracranial pressure measurement remains the cornerstone of neuromonitoring, analysis of the intracranial pressure waveform provides additional information, which may help guide treatment and predict outcome. Non-invasive detection of intracranial hypertension and assessment of cerebral perfusion pressure and autoregulation is the focus of ongoing research. Although jugular venous saturation monitoring remains a useful method for detecting global hypoperfusion its sensitivity to regional ischaemia is low. Brain tissue oxygen monitoring overcomes this deficiency and sheds new light on the pathophysiology of cerebral ischaemia following brain injury. Further studies are required to define ischaemic thresholds and their association with outcome. Extracellular brain pH has been recently linked to outcome and further studies are required to establish the role of pH regulation. Monitoring of brain metabolism using a cerebral microdialysis continues to develop its niche in clinical neuromonitoring, although it currently remains a research tool.

Summary

Multimodality neuromonitoring plays an important role in managing patients with severe head injury. It helps guide treatment, provides prognostic information and explores the pathophysiology of evolving brain injury.

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