Hemodynamic and neuro-monitoring for neurocritically ill patients: An international survey of intensivists

Abstract

Purpose: To investigate multimodality systemic and neuro-monitoring practices in acute brain injury (ABI) and to analyze differences among "neurointensivists" (NI; clinical practice comprised >1/3 by neurocritical care), and other intensivists (OI).

Methods: Anonymous 22-question Web-based survey among physician members of SCCM and ESICM.

Results: Six hundred fifty-five responded (66% completion rate); 422 (65%) were OI, and 226 (35%) were NI. More NI follow hemodynamic protocols for TBI (44.5% vs 33%, P=.007) and SAH (38% vs 21%, P<.001). For CPP optimization, NI use more arterial-waveform-analysis (AWA) (45% vs 35%, P=.019), and ultrasound (37.5% vs 28%, P=.023); NI use more PbtO₂ (28% vs 10%, P<.001). In the case scenario of raised ICP/low PbtO₂, most employ analgesia and/or sedation (47%) and osmotherapy (38%). More NI use pressure reactivity (vasopressor use OI 23% vs NI 34.5%, P=.014). For DCI, more NI target cardiac index (CI) (35% vs 21%, P<.001), and fluid responsiveness (62.5% vs 53%, P=.03). Also, NI use more angiography (57% vs 43.5%, P=.004), TCD (56.5% vs 38%, P<.001), CTP (32% vs16%, P<.001), and PbtO₂ (18% vs 7.5%, P=.001).

Conclusions: Intensivists with exposure to ABI patients employ more neuro- and hemodynamic monitoring. We found large heterogeneity and low overall use of advanced brain-physiology parameters.

Keywords: Brain injuries; Hemodynamics; Monitoring, neuromonitoring; Physiologic; Survey.