Skip to main content
SpringerLink
Log in

Neurologic and Systemic Monitoring in the NSU

  • Chapter
Critical Care Neurology and Neurosurgery

Part of the book series: Current Clinical Neurology ((CCNEU))

  • 308 Accesses

Abstract

Monitoring technologies assume particular importance in the neurosciences critical care unit (NSU). Beyond the cardiac and respiratory monitoring modalities common to other intensive care units (ICU), the NSU uses a wide array of technologies for both whole brain monitoring and regional or focal brain monitoring (Table 1). This chapter addresses these brain monitoring modalities and also considers recent advances in general ICU monitoring strategies that are equally important to the welfare of the NSU patient.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 299.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Jordan KG. Neurophysiologic monitoring in the neuroscience intensive care unit. Neurol. Clin. 1995; 13: 579–626.

    CAS  PubMed  Google Scholar 

  2. Rosner MJ. Pathophysiology and management of increased intracranial pressure. In: Andrews BT, ed. Neurosurgical Intensive Care. New York: McGraw-Hill, 1993, pp. 57–112.

    Google Scholar 

  3. Lang EW, Chestnut RM. Intracranial pressure: Monitoring and management. Neurosurg. Clin. North Am. 1994; 5: 573–588.

    CAS  Google Scholar 

  4. Lundberg N. Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr. Scand. 1960; 36 (Suppl 149): 1.

    CAS  Google Scholar 

  5. Guyot LL, Dowling C, Diaz FG, Michael DB. Cerebral monitoring devices: Analysis of complications. Acta Neurochir. (Suppl)1998; 71: 47–49.

    Google Scholar 

  6. Ostrup RC, Luersssen TG, Marshall LF, Zornow MH. Continuous monitoring of intracranial pressure with a miniaturized fiberoptic device. J. Neurosurg. 1987; 67: 206–209.

    Article  CAS  PubMed  Google Scholar 

  7. The American Association of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care. Indications for intracranial pressure monitoring. J. Neurotrauma 2000; 17: 479–491.

    Article  Google Scholar 

  8. Gibbs EL, Lennox WG, Gibbs FA. Bilateral internal jugular blood: Comparison of A-V differences, oxygen-dextrose ratios and respiratory quotients. Am. J. Psychiatry 1945; 102: 184.

    CAS  Google Scholar 

  9. Feldman Z, Robertson CS. Monitoring of cerebral hemodynamics with jugular bulb catheters. Crit. Care Clin. 1997; 13: 51–77.

    Article  CAS  PubMed  Google Scholar 

  10. Metz C, Holzschuh M, Bein T, Woertgen C, et al. Monitoring of cerebral oxygen metabolism in the jugular bulb: Reliability of unilateral measurements in severe head injury. J. Cereb. Blood Flow Metab. 1998; 18: 332–343.

    Article  CAS  PubMed  Google Scholar 

  11. Lam JMK, Chan MSY, Poon WS. Cerebral venous oxygen saturation monitoring: Is dominant jugular bulb cannulation good enough? Br. J. Neurosurg. 1996; 10: 357–364.

    Article  CAS  PubMed  Google Scholar 

  12. Robertson CS, Narayan RK, Gokaslan ZL, Pahwa R, et al. Cerebral arteriovenous oxygen difference as an estimate of cerebral blood flow in comatose patients. J. Neurosurg. 1989; 70: 222–230.

    Article  CAS  PubMed  Google Scholar 

  13. Cruz J, Miner ME, Allen SJ, Alves WM, Gennarelli TA. Continuous monitoring of cerebral oxygenation in acute brain injury: Assessment of cerebral hemodynamic reserve. Neurosurgery 1991; 29: 743–749.

    Article  CAS  PubMed  Google Scholar 

  14. Latronico N, Beindorf AE, Rasulo FA, Febbrari P, et al. Limits of intermittent jugular bulb saturation monitoring in the management of severe head trauma patients. Neurosurgery 2000; 46: 1131–1138.

    Article  CAS  PubMed  Google Scholar 

  15. Kirkpatrick PJ, Smielewski P, Czosnyka M, Menon D, Pickard JD. Near-infrared spectroscopy use in patients with head injury. J. Neurosurg. 1995; 83: 963–970.

    Article  CAS  PubMed  Google Scholar 

  16. Goetting MG, Preston G. Jugular bulb catheterization does not increase intracranial pressure. Intensive Care Med. 1991; 17: 195–198.

    Article  CAS  PubMed  Google Scholar 

  17. Browne TR, Holmes GL. Status epilepticus. In: Handbook of Epilepsy, 2nd ed. Philadelphia: Lippincott Williams Wilkins, 2000, pp. 197–214.

    Google Scholar 

  18. Young GB, Jordan KG, Doig GS. An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: An investigation of variables associated with mortality. Neurology 1996; 47: 83–89.

    Article  CAS  PubMed  Google Scholar 

  19. Wijdicks EFM. Determining brain death in adults. Neurology 1995; 45: 1003–1011.

    Article  CAS  PubMed  Google Scholar 

  20. Synek VM. Prognostically important EEG coma patterns in diffuse anoxic and traumatic encephalopathies in adults. J. Clin. Neurophysiol. 1988; 5: 161–174.

    Article  CAS  PubMed  Google Scholar 

  21. Aminoff MJ, Eisen AA. AAEM minimonograph 19: Somatosensory evoked potentials. Muscle Nerve 1998; 21: 277–290.

    Article  CAS  PubMed  Google Scholar 

  22. Diringer MN. Early prediction of outcome from coma. Curr. Opin. Neurol. Neurosurg. 1992; 5: 826.

    CAS  PubMed  Google Scholar 

  23. Goldie WD, Chiappa KH, Young RR, et al. Brain stem auditory and short-latency somatosensory evoked responses in brain death. Neurology 1981; 31: 248–256.

    Article  CAS  PubMed  Google Scholar 

  24. Zandbergen EGL, de Haan RJ, Stoutenbeek CP, Koelman JHTM, Hijdra A. Systematic review of early prediction of poor outcome in anoxic-ischaemic coma. Lancet 1998; 352: 1808–1812.

    Article  CAS  PubMed  Google Scholar 

  25. Moulton RJ, Brown JIM, Konasiewicz SJ. Monitoring severe head injury: A comparison of EEG and somatosensory evoked potentials. Can. J. Neurol. Sci. 1998;25:S7–S 11.

    Google Scholar 

  26. Tegeler CH, Babikian VL, Gomez CR. Neurosonology. St. Louis: Mosby, 1996.

    Google Scholar 

  27. Manno EM. Transcranial Doppler ultrasonography in the neurocritical care unit. Crit. Care Clin. 1997; 13: 79–104.

    Article  CAS  PubMed  Google Scholar 

  28. Aaslid R, Markwalder T, Nornes H. Noninvasive transcranial Doppler ultrasound recording of flow velocities in the basal cerebral arteries. J. Neurosurg. 1982; 57: 769–774.

    Article  CAS  PubMed  Google Scholar 

  29. Jobsis FF. Noninvasive, infrared monitoring of cerebral and myocardial oxygen sufficiency and circulatory parameters. Science 1977; 198: 1264–1267.

    Article  CAS  PubMed  Google Scholar 

  30. Adelson PD, Nemoto E, Scheuer M, Painter M, et al. Noninvasive continuous monitoring of cerebral oxygenation perüctally using near-infrared spectroscopy: A preliminary report. Epilepsia 1999; 40: 1484–1489.

    Article  CAS  PubMed  Google Scholar 

  31. Witham TF, Nemoto EM, Jungreis CA, Kaufmann AM. Near-infrared spectroscopy monitored cerebral venous thrombolysis. Can. J. Neurol. Sci. 1999; 26: 48–52.

    CAS  PubMed  Google Scholar 

  32. Nemoto EM, Yonas H, Kassam A. Clinical experience with cerebral oximetry in stroke and cardiac arrest. Crit. Care Med. 2000; 28: 1052–1054.

    Article  CAS  PubMed  Google Scholar 

  33. Gomersall CD, Joynt GM, Gin T, et al. Failure of the INVOS3100 cerebral oximeter to detect complete absence of cerebral blood flow. Crit. Care Med. 1997; 25: 1252–1254.

    Article  CAS  PubMed  Google Scholar 

  34. Lewis SB, Myburgh JA, Thornton EL, et al. Cerebral oxygenation monitoring by near-infrared spectroscopy is not clinically useful in patients with severe closed-head injury: A comparison with jugular venous bulb oximetry. Crit. Care Med. 1996; 24: 1334–1338.

    Article  CAS  PubMed  Google Scholar 

  35. Muellner T, Schramm W, Kwasny O, Vecsei V. Patients with increased intracranial pressure cannot be monitored using near infrared spectroscopy. Br. J. Neurosurg. 1998; 12: 136–139.

    Article  CAS  PubMed  Google Scholar 

  36. Anderson RE. Cerebral blood flow xenon-133. Neurosurg. Clin. North Am. 1996; 7: 703–708.

    CAS  Google Scholar 

  37. Martin NA, Doberstein C. Cerebral blood flow measurement in neurosurgical intensive care. Neurosurg. Clin. North Am. 1994; 5: 607–618.

    CAS  Google Scholar 

  38. Ingvar DH, Lassen NA. Quantitavie determination of cerebral blood flow in man. Lancet 1961; 2: 806–807.

    Article  Google Scholar 

  39. Halsey JH, Nakai K, Wariyar B. Sensitivity of rCBF to focal lesion. Stroke 1981; 12: 631–635.

    Article  PubMed  Google Scholar 

  40. Arbit E, DiResta GR. Application of laser Doppler flowmetry in neurosurgery. Neurosurg. Clin. North Am. 1996; 7: 741–748.

    CAS  Google Scholar 

  41. Haberl PL, Villringer A, Dirnagl U. Applicability of laser-Doppler flowmetry for cerebral blood flow monitoring in neurological intensive care. Acta Neurochir (Suppl) 1993; 59: 64–68.

    CAS  Google Scholar 

  42. Stern MD, Lappe LD, Bowen PD, et al. Continuous measurement of tissue blood flow by laser-Doppler spectroscopy. Am. J. Physiol. 1977; 232: H441–H448.

    CAS  PubMed  Google Scholar 

  43. Kirkpatrick PJ, Smielewski P, Czosnyka M, Pickard JD. Continuous monitoring of cortical perfusion by laser Doppler flowmetry in ventilated patients with head injury. J. Neurol. Neurosurg. Psych. 1994; 57: 1382–1388.

    Article  CAS  Google Scholar 

  44. Meyerson BA, Gunasekera L, Linderoth B, Gazelius B. Bedside monitoring of regional cortical blood flow in comatose patients using laser Doppler flowmetry. Neurosurgery 1991; 29: 750–755.

    Article  CAS  PubMed  Google Scholar 

  45. Gibbs FA. A thermoelectric blood flow recorder in the form of a needle. In: Proceedings of the Society for Experimental Biology and Medicine, San Francisco 1933, pp. 141–146.

    Google Scholar 

  46. Carter LP, Weinand ME, Oommen KJ. Cerebral blood flow (CBF) monitoring in intensive care by thermal diffusion. Acta Neurochir. 1993;(Suppl)59:43–46.

    Google Scholar 

  47. Carter LP. Thermal diffusion flowmetry. Neurosurg. Clin. North Am. 1996; 7: 749–754.

    CAS  Google Scholar 

  48. Sioutos PJ, Orozco JZ, Carter LP, Weinand ME, et al. Continuous regional cerebral cortical blood flow monitoring in head-injured patients. Neurosurgery 1995; 36: 943–950.

    Article  CAS  PubMed  Google Scholar 

  49. Bolinder J, Ungerstedt U, Arner P. Long-term continuous glucose monitoring with microdialysis in ambulatory insulin-dependent diabetic patients. Lancet 1993; 342: 1080–1085.

    Article  CAS  PubMed  Google Scholar 

  50. Hutchinson PJA, O’Connell MY, Maskell LB, Pickard JD. Monitoring by subcutaneous microdialysis in neurosurgical intensive care. Acta Neurochir. (Suppl) 1999; 75: 57–59.

    Article  CAS  Google Scholar 

  51. Nilsson OG, Brandt L, Ungerstedt U, Saveland H. Bedside detection of brain ischemia using intracerebral microdialysis: Subarachnoid hemorrhage and delayed ischemic deterioration. Neurosurgery 1999; 45: 1176–1185.

    Article  CAS  PubMed  Google Scholar 

  52. Schulz MK, Wang LP Tange M, Bjerre P. Cerebral microdialysis monitoring: determination of normal and ischemic cerebral metabolisms in patients with aneurysmal subarachnoid hemorrhage. J. Neurosurg. 2000; 93: 808–814.

    Article  CAS  PubMed  Google Scholar 

  53. Vespa P, Prins M, Ronne-Engstrom E, Caron M, et al. Increase in extracellular glutamate caused by reduced cerebral perfusion and seizures after human traumatic brain injury: a microdialysis study. J. Neurosurg. 1998; 89: 971–982.

    Article  CAS  PubMed  Google Scholar 

  54. Berger C, Annecke A, Aschoff A, et al. Neurochemical monitoring of fatal middle cerebral artery infarction. Stroke 1999; 30: 460–463.

    Article  CAS  PubMed  Google Scholar 

  55. During MJ, Spencer DD. Extracellular hippocampal glutamate and spontaneous seizure in the conscious human brain. Lancet 1993; 341: 1607–1610.

    Article  CAS  PubMed  Google Scholar 

  56. Mendelowitsch A, Sekhar LN, Wright DC, et al. An increase in intracellular glutamate is a sensitive method of detecting ischaemic neuronal damage during cranial base and cerebrovascular surgery: An in vivo microdialysis study. Acta Neurochir. 1998; 140: 349–355.

    Article  CAS  PubMed  Google Scholar 

  57. Landolt H, Langemann H, Alessandri B. A concept for the introduction of cerebral microdialysis in neurointensive care. Acta Neurochir. 1996;(Suppl)67:31–36.

    Google Scholar 

  58. Andrews RJ. Monitoring for neuroprotection: New technologies for the new millennium. Ann. NY Acad. Sci. 2000: 101–113.

    Google Scholar 

  59. van Santbrink H, Maas AIR, Avezaat CJJ. Continuous monitoring of partial pressure of brain tissue oxygen in patients with severe head injury. Neurosurgery 1996; 38: 21–31.

    Article  PubMed  Google Scholar 

  60. Kiening KL, Unterberg AW, Bardt TF, et al. Monitoring of cerebral oxygenation in patients with severe head injuries: brain tissue pO2 versus jugular vein oxygen saturation. J. Neurosurg. 1996; 85: 751–757.

    Article  CAS  PubMed  Google Scholar 

  61. van den Brink WA, van Santbrink H, Steyerberg EW, et al. Brain oxygen tension in severe head injury. Neurosurgery 2000; 46: 868–878.

    PubMed  Google Scholar 

  62. Valadka AB, Shankar SP, Contant CF, et al. Relationship of brain tissue pO2 to outcome after severe head injury. Crit. Care Med. 1998; 26: 1576–1581.

    Article  CAS  PubMed  Google Scholar 

  63. Alvarez del Castillo M. Monitoring neurologic patients in intensive care. Curr. Opin. Crit. Care 2001; 7: 49–60.

    Article  Google Scholar 

  64. Hoffman WE, Wheeler P, Edelman G. Hypoxic brain tissue following subarachnoid hemorrhage. Anesthesiology 2000; 92: 442–446.

    Article  CAS  PubMed  Google Scholar 

  65. Zimmerman JL, Dellinger RP. Blood gas monitoring. Crit. Care Clin. 1996; 12: 865–874.

    Article  CAS  PubMed  Google Scholar 

  66. Giuliano KK, Giuliano AJ, Scott SS, et al. Temperature measurement in critically ill adults: a comparison of tympanic and oral methods. Am. J. Crit. Care 2000; 9: 254–261.

    CAS  PubMed  Google Scholar 

  67. Fallis WM. Oral measurement of temperature in orally intubated critical care patients: state-of-the-science review. Am. J. Crit. Care 2000; 9: 334–343.

    CAS  PubMed  Google Scholar 

  68. Kirkpatrick PJ, Czosnyka M, Pickard JD. Multimodal monitoring in neurointensive care. J. Neurol. Neurosurg. Psychiatry 1996; 60: 131–139.

    Article  CAS  PubMed  Google Scholar 

  69. Khan SH, Kureshi IU, Mulgrew T, et al. Comparison of percutaneous ventriculostomies and intraparenchymal monitor: A retrospective evaluation of 156 patients. Acta Neurochir. (Suppl) 1998; 71: 50–52.

    CAS  Google Scholar 

  70. Sheinberg M, Kanter MJ, Robertson CS, et al. Continuous monitoring of jugular venous oxygen saturation in head-injured patients. J. Neurosurg. 1992; 76: 212–217.

    Article  CAS  PubMed  Google Scholar 

  71. Hassler W, Steinmetz H, Gawlowski J. Transcranial Doppler ultrasonography in raised intracranial pressure and in intracranial circulatory arrest. J. Neurosurg. 1988; 68: 745–751.

    CAS  PubMed  Google Scholar 

  72. Wardlaw JM, Offin R, Teasdale GM, et al. Is routine transcranial Doppler ultrasound monitoring useful in the management of subarachnoid hemorrhage? J. Neurosurg. 1998; 88: 272–276.

    Article  CAS  PubMed  Google Scholar 

  73. Brass LM, Pavlakis SG, DeVivo D, et al. Transcranial Doppler measurements of the middle cerebral artery: Effect of hematocrit. Stroke 1988; 19: 1466–1469.

    Article  CAS  PubMed  Google Scholar 

  74. Recommendations for intracranial pressure monitoring technology. J. Neurotrauma 2000; 17: 497–505.

    Article  Google Scholar 

Download references

Authors
  1. Daniel W. Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jose I. Suarez
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Neurosciences Critical Care, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA

    Jose I. Suarez MD

Rights and permissions

Reprints and permissions

Copyright information

© 2004 Springer Science+Business Media New York

About this chapter

Cite this chapter

Miller, D.W., Suarez, J.I. (2004). Neurologic and Systemic Monitoring in the NSU. In: Suarez, J.I. (eds) Critical Care Neurology and Neurosurgery. Current Clinical Neurology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-660-7_6

Download citation

  • DOI: https://doi.org/10.1007/978-1-59259-660-7_6

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61737-350-3

  • Online ISBN: 978-1-59259-660-7

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation