Document Detail


Neurologic intensive care unit monitoring.
MedLine Citation:
PMID:  3916779     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Monitoring modalities unique to the neurologic intensive care unit include intracranial pressure monitors and neuroelectrophysiologic monitors. Each modality fullfills criteria for accuracy, responsivity during clinical change, and stability over time for trend analysis. Intracranial pressure monitoring may be accomplished by any of three approaches--ventricular catheter, subarachnoid bolt, or epidural pressure transducer. Intracranial pressure control has proved beneficial in at least three different illnesses--acute closed head injury, acute noncommunicating hydrocephalus, and Reye's syndrome. Other illnesses, such as cerebral hemorrhage, near drowning, meningitis, encephalitis, and cerebral mass lesions, are often associated with ICP elevations. Neuroelectrophysiologic monitoring encompassing electroencephalography (EEG), signal-processed EEG, and evoked potentials has proved to be most beneficial to the intensive care setting. Evoked potentials are most useful for monitoring patients in drug-induced coma or muscle paralysis in whom a clinical neurologic examination is unreliable. Focal neurologic deficits, incipient brainstem ischemia, and possibly brain death can be deduced from multimodality-evoked potentials (brainstem auditory and somatosensory). Evoked potential apparatus can be used to record sequential stimuli and trend changes. Signal-processed EEG apparatus (compressed spectral array and cerebral function monitor) are used to assess global or regional EEG activity for longer periods of time. Interpretation of signal-processed EEG recording requires some experience with this technique, but it is much easier to interpret than a standard 16-lead EEG. These monitors are useful in evaluating some forms of abnormal EEG activity and in monitoring gross changes in global or regional electrical activity. Currently available technology offers dynamic insight into the management of acute neurologic illnesses. The technology in evoked potential and signal processed EEG monitoring will eventually reduce the size and complexity of the instrumentation, making its application routine. Intracranial pressure monitoring is already routine in many intensive care units, although its use is occasionally sporadic. We believe that application of appropriate neurologic monitors improves therapy and outcome in neurologically injured and ill patients.
Authors:
C Borel; D Hanley
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Critical care clinics     Volume:  1     ISSN:  0749-0704     ISO Abbreviation:  Crit Care Clin     Publication Date:  1985 Jul 
Date Detail:
Created Date:  1988-09-22     Completed Date:  1988-09-22     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  8507720     Medline TA:  Crit Care Clin     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  223-39     Citation Subset:  IM    
Affiliation:
Neurologic Critical Care Unit, Johns Hopkins Medical Institutions, Baltimore, Maryland.
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MeSH Terms
Descriptor/Qualifier:
Critical Care / methods*
Electroencephalography / methods
Electrophysiology
Humans
Intracranial Pressure
Monitoring, Physiologic / methods*
Nervous System Diseases / diagnosis*,  physiopathology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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