| Intracranial multimodal monitoring for acute brain injury: a single institution review of current practices. | |
| | |
MedLine Citation:
|
PMID: 20107926 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: Critical care management of patients with severe acute brain injury has undergone tremendous advances. Neurosurgeons and neurointensivists have a large armamentarium of invasive monitoring devices available to help detect secondary brain injury and guide therapy. No consensus exists regarding patient specific selection of monitoring devices, the placement of devices in relation to injured brain tissue, or the preferred insertion technique. Here we review our experience in a consecutive series of acutely brain injured patients who underwent multimodality monitoring. METHODS: Sixty-one patients admitted to the Neurological Intensive Care Unit underwent multimodality intracranial monitoring between January 2005 and October 2008. Patient demographics, hospital length of stay, types of monitoring devices and modalities monitored, insertion techniques, device placement location relative to injury, and complications are reported. RESULTS: Monitored modalities included brain tissue oxygen (PbtO(2)) in 97% (N = 59), microdialysis (MD) in 79% (N = 48), intracranial electroencephalography in 31% (N = 19), brain temperature in 18% (N = 11), and cerebral blood flow in 11% (N = 7). On average, monitoring started within 2 days (0-8) of admission and was continued for 7 days (1-17). The majority of probes (56%; N = 35) were placed into patients with focal brain injuries, while in 43% N = 26 the injury was diffuse. Among those with focal injury, probe placement was categorized as peri-lesional in 46% (N = 16), and within a clot or infarct in 17% (N = 6). The most frequent complication of multimodality brain monitoring was device malfunction or dislodgement (43%; N = 26). Rates of hematoma and infection were 3 and 5%, respectively. Average NICU length of stay was 17 days (3-48) and 26% (N = 16) of patients were dead at discharge. CONCLUSIONS: Collaboration among institutions is necessary to establish practice guidelines for the choice and placement of multimodal monitors. Further advancement in device technology is needed to improve insertion techniques, inter-device compatibility, and device durability. Multimodality data needs to be analyzed to determine the preferable device location. |
| | |
Authors:
|
R Morgan Stuart; Michael Schmidt; Pedro Kurtz; Allen Waziri; Raimund Helbok; Stephan A Mayer; Kiwon Lee; Neeraj Badjatia; Lawrence J Hirsch; E Sander Connolly; Jan Claassen |
Related Documents
:
|
18936376 - Safety of early mobilization of patients with blunt solid organ injuries. 14660236 - Functional outcome following botulinum toxin a injection to reduce spastic equinus in a... 19131816 - Blunt cerebrovascular injuries: does treatment always matter? 17609836 - Biomechanics of road traffic collision injuries: a clinician's perspective. 1586086 - Diagnosis and treatment of enterovesical fistulae. 21763836 - Preserving bowel length with a transluminal stent in neonates with multiple intestinal ... |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: Neurocritical care Volume: 12 ISSN: 1556-0961 ISO Abbreviation: Neurocrit Care Publication Date: 2010 Apr |
Date Detail:
|
Created Date: 2010-03-23 Completed Date: 2010-06-23 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 101156086 Medline TA: Neurocrit Care Country: United States |
Other Details:
|
Languages: eng Pagination: 188-98 Citation Subset: IM |
Affiliation:
|
Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Anticonvulsants
/
therapeutic use Body Temperature / physiology Brain / metabolism* Brain Injuries / complications, metabolism*, surgery Combined Modality Therapy Electroencephalography Female Humans Intensive Care Units / statistics & numerical data* Male Middle Aged Monitoring, Physiologic / methods Neurosurgical Procedures Oxygen / metabolism* Retrospective Studies Seizures / diagnosis, etiology, prevention & control Severity of Illness Index Stroke / complications, metabolism*, surgery Subarachnoid Hemorrhage / complications, metabolism*, surgery |
| Chemical | |
Reg. No./Substance:
|
0/Anticonvulsants; 7782-44-7/Oxygen |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Oxygen Tension Modulates Neurite Outgrowth in PC12 Cells Through A Mechanism Involving HIF and VEGF.
Next Document: Cyclophosphamide and lupus nephritis: when, how, for how long?