Abstract
Regional multimodality monitoring has evolved over the last several years as a tool to understand the mechanisms of brain injury and brain function at the cellular level. Multimodality monitoring offers an important augmentation to the clinical exam and is especially useful in comatose neurocritical care patients. Cerebral microdialysis, brain tissue oxygen monitoring, and cerebral blood flow monitoring all offer insight into permutations in brain chemistry and function that occur in the context of brain injury. These tools may allow for development of individual therapeutic strategies that are mechanistically driven and goal-directed. We present a summary of the discussions that took place during the Second Neurocritical Care Research Conference regarding regional brain monitoring.
Similar content being viewed by others
References
Tossman U, Ungerstedt U. Microdialysis in the study of extracellular levels of amino acids in the rat brain. Acta Physiol Scand. 1986;128(1):9–14.
Tossman U, Segovia J, Ungerstedt U. Extracellular levels of amino acids in striatum and globus pallidus of 6-hydroxydopamine-lesioned rats measured with microdialysis. Acta Physiol Scand. 1986;127(4):547–51.
Tossman U, Wieloch T, Ungerstedt U. Gamma-Aminobutyric acid and taurine release in the striatum of the rat during hypoglycemic coma, studied by microdialysis. Neurosci Lett. 1985;62(2):231–5.
Meyerson BA, Linderoth B, Karlsson H, Ungerstedt U. Microdialysis in the human brain: extracellular measurements in the thalamus of parkinsonian patients. Life Sci. 1990;46(4):301–8.
Hillered L, Persson L, Ponten U, Ungerstedt U. Neurometabolic monitoring of the ischemic human brain using microdialysis. Acta Neurochir (Wien). 1990;102(3–4):91–7.
Reinstrup P, Stahl N, Mellergard P, Uski T, Ungerstedt U, Nordstrom CH. Intracerebral microdialysis in clinical practice: baseline values for chemical markers during wakefulness, anesthesia, and neurosurgery. Neurosurgery. 2000;47(3):701–9.
Enblad P, Valtysson J, Andersson J, Lilja A, Valind S, Antoni G, et al. Simultaneous intracerebral microdialysis and positron emission tomography in the detection of ischemia in patients with subarachnoid hemorrhage. J Cereb Blood Flow Metab. 1996;16(4):637–44.
Frykholm P, Hillered L, Langstrom B, Persson L, Valtysson J, Watanabe Y, et al. Increase of interstitial glycerol reflects the degree of ischemic brain damage: a PET and microdialysis study in a middle cerebral artery occlusion-reperfusion primate model. J Neurol Neurosur Psychiatry. 2001;71(4):455–61.
Robertson CS, Gopinath SP, Uzura M, Valadka AB, Goodman JC. Metabolic changes in the brain during transient ischemia measured with microdialysis. Neurol Res. 1998;20(Suppl 1):S91–4.
Kawamata T, Katayama Y, Hovda DA, Yoshino A, Becker DP. Administration of excitatory amino acid antagonists via microdialysis attenuates the increase in glucose utilization seen following concussive brain injury. J Cereb Blood Flow Metab. 1992;12(1):12–24.
Bergsneider M, Hovda DA, McArthur DL, Etchepare M, Huang SC, Sehati N, et al. Metabolic recovery following human traumatic brain injury based on FDG-PET: time course and relationship to neurological disability. J Head Trauma Rehabil. 2001;16(2):135–48.
Hovda DA, Yoshino A, Kawamata T, Katayama Y, Becker DP. Diffuse prolonged depression of cerebral oxidative metabolism following concussive brain injury in the rat: a cytochrome oxidase histochemistry study. Brain Res. 1991;567(1):1–10.
Vink R, Faden AI, McIntosh TK. Changes in cellular bioenergetic state following graded traumatic brain injury in rats: determination by phosphorus 31 magnetic resonance spectroscopy. J Neurotrauma. 1988;5(4):315–30.
Vespa P, Bergsneider M, Hattori N, Wu HM, Huang SC, Martin NA, et al. Metabolic crisis without brain ischemia is common after traumatic brain injury: a combined microdialysis and positron emission tomography study. J Cereb Blood Flow Metab. 2005;25(6):763–74.
Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W, et al. A trial of intracranial-pressure monitoring in traumatic brain injury. New Engl J Med. 2012;367(26):2471–81.
Maloney-Wilensky E, Gracias V, Itkin A, Hoffman K, Bloom S, Yang W, et al. Brain tissue oxygen and outcome after severe traumatic brain injury: a systematic review. Crit Care Med. 2009;37(6):2057–63.
Chang JJ, Youn TS, Benson D, Mattick H, Andrade N, Harper CR, et al. Physiologic and functional outcome correlates of brain tissue hypoxia in traumatic brain injury. Crit Care Med. 2009;37(1):283–90.
Oddo M, Levine JM, Mackenzie L, Frangos S, Feihl F, Kasner SE, et al. Brain hypoxia is associated with short-term outcome after severe traumatic brain injury independently of intracranial hypertension and low cerebral perfusion pressure. Neurosurgery. 2011;69(5):1037–45 discussion 45.
Nangunoori R, Maloney-Wilensky E, Stiefel M, Park S, Andrew Kofke W, Levine JM, et al. Brain tissue oxygen-based therapy and outcome after severe traumatic brain injury: a systematic literature review. Neurocrit Care. 2012;17(1):131–8.
Smielewski P, Lavinio A, Timofeev I, Radolovich D, Perkes I, Pickard JD, Czosnyka M. ICM+, a flexible platform for investigations of cerebrospinal dynamics in clinical practice. Acta Neurochir Suppl. 2008;102:145–51.
Balestreri M, Czosnyka M, Steiner LA, Hiler M, Schmidt EA, Matta B, Menon D, Hutchinson P, Pickard JD. Association between outcome, cerebral pressure reactivity and slow ICP waves following head injury. Acta Neurochir Suppl. 2005;95:25–8.
Czosnyka M, Smielewski P, Kirkpatrick P, Laing RJ, Menon D, Pickard JD. Continuous assessment of the cerebral vasomotor reactivity in head injury. Neurosurgery. 1997;41(1):11–7 discussion 17–19.
Timofeev I, Czosnyka M, Nortje J, Smielewski P, Kirkpatrick P, Gupta A, Hutchinson P. Effect of decompressive craniectomy on intracranial pressure and cerebrospinal compensation following traumatic brain injury. J Neurosurg. 2008;108(1):66–73.
Czosnyka M, Smielewski P, Kirkpatrick P, Menon DK, Pickard JD. Monitoring of cerebral autoregulation in head-injured patients. Stroke. 1996;27(10):1829–34.
Czosnyka M, Smielewski P, Lavinio A, Pickard JD, Panerai R. An assessment of dynamic autoregulation from spontaneous fluctuations of cerebral blood flow velocity: a comparison of two models, index of autoregulation and mean flow index. Anesth Analg. 2008;106(1):234–9.
Schmidt EA, Czosnyka M, Steiner LA, Balestreri M, Smielewski P, Piechnik SK, Matta BF, Pickard JD. Asymmetry of pressure autoregulation after traumatic brain injury. J Neurosurg. 2003;99(6):991–8.
Budohoski KP, Reinhard M, Aries MJ, Czosnyka Z, Smielewski P, Pickard JD, Kirkpatrick PJ, Czosnyka M. Monitoring cerebral autoregulation after head injury. Which component of transcranial Doppler flow velocity is optimal? Neurocrit Care. 2012;17(2):211–8.
Al-Rawi PG, Kirkpatrick PJ. Tissue oxygen index: thresholds for cerebral ischemia using near-infrared spectroscopy. Stroke. 2006;37(11):2720–5.
Budohoski KP, Czosnyka M, Smielewski P, Kasprowicz M, Helmy A, Bulters D, Pickard JD, Kirkpatrick PJ. Impairment of cerebral autoregulation predicts delayed cerebral ischemia after subarachnoid hemorrhage: a prospective observational study. Stroke. 2012;43(12):3230–7.
Wong GK, Liang M, Tan H, Lee MW, Po YC, Chan KY, Poon WS. High-dose simvastatin for aneurysmal subarachnoid hemorrhage: a multicenter, randomized, controlled, double-blind clinical trial protocol. Neurosurgery. 2013;72(5):840–4.
Diringer MN, Yundt K, Videen TO, Adams RE, Zazulia AR, Deibert E, Aiyagari V, Dacey RG Jr, Grubb RL Jr, Powers WJ. No reduction in cerebral metabolism as a result of early moderate hyperventilation following severe traumatic brain injury. J Neurosurg. 2000;92(1):7–13.
Steiner LA, Coles JP, Johnston AJ, Chatfield DA, Smielewski P, Fryer TD, Aigbirhio FI, Clark JC, Pickard JD, Menon DK, Czosnyka M. Assessment of cerebrovascular autoregulation in head-injured patients: a validation study. Stroke. 2003;34(10):2404–9.
Schramm P, Klein KU, Pape M, Berres M, Werner C, Kochs E, Engelhard K. Serial measurement of static and dynamic cerebrovascular autoregulation after brain injury. J Neurosurg Anesthesiol. 2011;23(1):41–4.
Jost SC, Diringer MN, Zazulia AR, Videen TO, Aiyagari V, Grubb RL, Powers WJ. Effect of normal saline bolus on cerebral blood flow in regions with low baseline flow in patients with vasospasm following subarachnoid hemorrhage. J Neurosurg. 2005;103(1):25–30.
Diringer MN. Management of aneurysmal subarachnoid hemorrhage. Crit Care Med. 2009;37:432–40.
Dhar R, Zazulia AR, Videen TO, Zipfel GJ, Derdeyn CP, Diringer MN. Red blood cell transfusion increases cerebral oxygen delivery in anemic patients with subarachnoid hemorrhage. Stroke. 2009;40(9):3039–44.
Dhar R, Scalfani MT, Zazulia AR, Videen TO, Derdeyn CP, Diringer MN. Comparison of induced hypertension, fluid bolus, and blood transfusion to augment cerebral oxygen delivery after subarachnoid hemorrhage. J Neurosurg. 2012;116(3):648–56.
Bohman LE, Heuer GG, Macyszyn L, Maloney-Wilensky E, Frangos S, Le Roux PD, Kofke A, Levine JM, Stiefel MF. Medical management of compromised brain oxygen in patients with brain injury. Neurocrit Care. 2011;14(3):361–9.
Acknowledgments
The Second Neurocritical Care Research Conference was funded by the National Institutes of Health (NINDS) (R13 NS077610, PI: Suarez JI), the Integra Foundation, and the Baylor St Luke’s Medical Center in Houston, TX.
Author information
Authors and Affiliations
Consortia
Corresponding author
Additional information
The Second Neurocritical Care Research Conference Investigators are listed in “Appendix”
Appendix
Appendix
List of Second Neurocritical Care Research Conference Investigators in Alphabetical Order
Abdelhak Tamer, MD, Henry Ford Hospital, Detroit, MI; Aisiku Imolgele, MD, UT Houston, Houston, TX; Alderazai Yazan, MD, UT Houston, Houston, TX; Safdar Ansari, MD, Baylor College of Medicine, Houston, TX; Armstead William, MD, University of Pennsylvania, Philadelphia, PA; Badjatia Neeraj, MD, Columbia University, New York, NY; Bele Sylvia, MD, Regensburg, Germany; Bernard Francis, MD, University of Montreal, Montreal, Quebec; Bershad Eric, MD, Baylor College of Medicine, Houston, TX; Bowman Deanna, Hemedex Inc, Cambridge, MA; Bowman Frederick, PhD, Hemedex Inc, Cambridge, MA; Calvillo Eusebia, RN, Baylor College of Medicine, Houston, TX; Castillo-Abrego Guadalupe, MD, Panama City, Panama; Cava Luis, MD, University of Colorado, Denver, CO; Chang Cherylee, MD, Queens Medical Center, Honolulu, HI; Chesnut Randall, MD, University of Washington, Seattle, WA; Chhangani Sanjeev, MD, Massachusetts General Hospital, Boston, MA; Chumbe Maria, MD, Insituto Neurologico, Lima, Peru; Ciro-Quintero Juan Diego, MD, Clinica Las Americas, Medellin, Colombia; Citerio Giuseppe, MD, San Gerardo Hospital, Monza, Italy; Clark Robert, MD, PhD, University of Pittsburgh, Pittsburgh, PA, Coffey Lisa, Hemedex Inc, Cambridge, MA; Corry Jesse, MD, Marshfield Clinic, Marshfield, WI; Coplin William, MD, Wayne State University, Detroit, MI; Dhar Rajat, MD, Washington University, St Louis, MO; Diringer Michael, MD, Washington University, St Louis, MO; Divani Afshin, PhD, University of Minnesota, Minneapolis, MN; Domingues Joao, MD, Brazil; Elzammar Ziad, MD, SUNY Upstate Medical University, Syracuse, NY; Ezzedine Mustapha, MD, University of Minnesota, Minneapolis, MN; Figolt Doug, Codman Neuro, Raynham, MA; Figueroa Stephen, MD, UT Southwestern, Dallas, TX; Freeman William, MD, Mayo Clinic, Jacksonville, Fl; Fugate Jennifer, MD, Mayo Clinic, Rochester, MN; Fuse Akira, MD, Nippon Medical School, Tokyo, Japan; Geocadin Romergryko, MD, Johns Hopkins University, Baltimore, MD; Giraldo Elias, MD, Drexel University College of Medicine, Philadelphia, PA; Girardeau Rosemarie, RN, Integra Neurosciences, Plainsboro, NJ; Glassner Stuart, MD, University of Miami, Miami, Fl; Gomez Mauricio, MD, Los Angeles, CA; Goodman Jerry, MD, Baylor College of Medicine, Houston, TX; Gopinath Shankar, MD, Baylor College of Medicine, Houston, TX; Gress Daryl, MD, University of Viriginia, Charlottesville, VA; Grocott Hilary, MD, University of Manitoba, Winnipeg, MB; Gupta Puneet, MD, UT Southwestern, Dallas, TX; Haider Huma, Baylor College of Medicine, Houston, TX; Halinger Mangat, MD, Cornell University, New York, NY; Hall Casey, MD, Emory University, Atlanta, GA; Hall Christiana, MD, UT Southwestern, Dallas, TX; Hannawi Yousef, MD, Baylor College of Medicine, Houston, TX; Hemphill J Claude, MD, PhD, UCSF, San Francisco, CA; Hernandez Olga H, MD, Instituto Neurologico de Colombia, Medellin, Colombia; Hinson Holly, MD, OHSU, Portland, OR; Hocker Sara, MD, Mayo Clinic, Rochester, MN; Jones Elizabeth, RN, Baylor St Luke’s Medical Center, Houston, TX; James Michael, MD, Duke University, Durham, NC; Jichici Draga, MD, McMaster University, Hamilton, ON; Kapinos Gregory, MD, North Shore Hospital LIJ, Long Island, NY; Kirkpatrick Peter, University of Cambridge, Cambridge, UK; Ko Nerissa, MD, UCSF, San Francisco, CA; Kofke Andrew, MD, University of Pennsylvania, Philadelphia, PA; Koterba Edwin, MD, University of Sao Paulo, Brazil; Kramer Andreas, MD, Calgary, AB; Kuramatsu Joji, MD, Univ of Erlangen, Germany; Kutsogiannis Demetrios, MD, University of Alberta, Edmonton, AB; Latorre Julius, MD, SUNY Upstate Medical University, Syracuse, NY; Lazaridis Christos, MD, Baylor College of Medicine, Houston, TX; Ledoux David, MD, North Shore Hospital LIJ, Long Island, NY; Lee Jennifer, MD, Baylor College of Medicine, Houston, TX; Leroux Peter, MD, University of Pennsylvania, Philadelphia, PA; Liebschner Michael, PhD, Baylor College of Medicine; Livesay Sarah, RN, PhD, Baylor St Luke’s Medical Center, Houston, TX; Lopez Hubiel, MD, CEDIMAT, Dominican Republic; Luedtke Michael, Codman Neuro, Raynham, MA; Maas Andrew, MD, University Hospitals Antwerp, Belgium; Mandava Pitchaiah, MD, PhD, Baylor College of Medicine, Houston, TX; Manno Edward, MD, CCF, Cleveland, OH; March Karen, RN, Integra Neurosciences, Plainsboro, NJ; Martin Renee, PhD, MUSC, Charleston, SC; McCullough Laurence, PhD, Baylor College of Medicine, Houston, TX; Mejia Jorge H, MD, Fundacion Valle del Lili, Colombia; Miller Emmy, RN, PhD, Baylor College of Medicine, Houston, TX; Mizrahi Eli, MD, Baylor College of Medicine, Houston, TX; Moberg Richard, PhD, Moberg Research, Ambler, PA; Molyneaux Bradley, MD, Massachusetts General Hospital, Boston, MA; Muehlschlegel Susanne, MD, Dr med, UMass, Worcester, MA; Murthy Harish, MD, Good Samaritan Hospital, San Jose, CA; Murthy Santosh, MD, Baylor College of Medicine, Houston, TX; Norris Gregory, MD, Wayne State University, Detroit, MI; Nguyen Thuy, PharmD, Baylor St Luke’s Medical Center, Houston, TX; Nyquist Paul, MD, PhD, Johns Hopkins University, Baltimore, MD; Olson Daiwai, RN, PhD, Duke University, Durham, NC; O’Phelan Kristine, MD, University of Miami, Miami, FL; Palesch Yuko, PhD, MUSC, Charleston, SC; Parikh Gunjan, MD, Columbia University, New York, NY; Park Soojin, MD, University of Pennsylvania, Philadelphia, PA; Prado Darwin, MD, Rio de Janeiro, Brazil; Rajajee Venkatakrishna, MD, University of Michigan, Ann Arbor, MI; Ramirez Jorge, MD, San Jose, Costa Rica; Venkatasubba Rao Chethan P, MD, Baylor College of Medicine, Houston, TX; Rehman Mohammed, MD, Henry Ford Hospital, Detroit, MI; Rethnam Rajesh, MD, Houston, TX; Rigamonti Andrea, MD, University of Toronto, Toronto, ON; Robertson Claudia, MD, Baylor College of Medicine, Houston, TX; Rosand Jonathan, MD, Massachusetts General Hospital, Boston, MA; Rymer Marilyn, MD, St Luke’s Hospital, Kansas City, MO; Sachdev Harmeet, MD, Good Samaritan Hospital, San Jose, CA; Sarwal Aarti, MD, Wake Forest University, Winston Salem, NC; Schmidt Michael J, PhD, Columbia University, New York, NY; Schneck J MICHAEL, MD, Loyola University, Chicago, Il; Schneider Hauke, MD, Technical University, Dresden,Germany; Seder David, MD, Tufts University, Boston, MA; Shah Shreyansh, MD, Baylor College of Medicine, Houston, TX; Sheth Kevin, MD, University of Maryland, Baltimore, MD; Shutter Lori, MD, University of Cincinnati, Cincinnati, OH; Siegel Sherry, MD, Integra Neurosciences, Plainsboro, NJ; Silva Ricardo, MD, Rio de Janeiro, Brazil; Smirnakis Stelios M, MD, PhD, Baylor College of Medicine, Houston, TX; Souter Michael, MD, University of Washington, Seattle, WA; Staykov Dimitre, MD, University of Erlangen, Germany; Stiver Shirley, MD, UCSF, San Francisco, CA; Suarez Jose I, MD, Baylor College of Medicine, Houston, TX; Sung Gene, MD, University of Southern California, Los Angeles, CA; Suri Muhammad Fareed, MD, University of Minnesota, Minneapolis, MN; Tirschwell David, MD, University of Washington, Seattle, WA; Torbey Michel, MD, OSU, Columbus, OH; Trapuzzano Gary, Moberg Research, Ambler, PA; Treggiari Miriam, MD, University of Washington, Seattle, WA; Turgeon Alexis, MD, Universite Laval, Quebec, Quebec; Urfy Zain, MD, Baylor College of Medicine, Houston, TX; Varelas Panayiotis, MD, PhD, Henry Ford Hospital, Detroit, MI; Villalobos Luis, MD, Buenos Aires, Argentina; Wijman Christine, MD, PhD, Stanford University, Palo Alto, CA; Yonas Howard, MD, University of New Mexico, Albuquerque, NM; Yuste Fernando, MD, BARD Medical, Covington, GA; Zafar Sahar, MD, Baylor College of Medicine, Houston, TX; Zygun David, MD, University of Calgary, Calgary, AB.
Rights and permissions
About this article
Cite this article
Frontera, J., Ziai, W., O’Phelan, K. et al. Regional Brain Monitoring in the Neurocritical Care Unit. Neurocrit Care 22, 348–359 (2015). https://doi.org/10.1007/s12028-015-0133-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12028-015-0133-x