Essential Noninvasive Multimodality Neuromonitoring for the Critically Ill Patient

Abstract

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

Fig. 1

Examples of the automated infrared pupillometry devices available on the market

Fig. 2

Functions of pupillometry

Fig. 3

Main approaches to transcranial ultrasonography

Fig. 4

Left panel: Midbrain as the main landmark to explore the circle of Willis; once that is found, the power Doppler can be started to scan for intracranial arteries. Right panel: Lateral ventricles in a severe TBI patient with pronounced midline shift and trans-tentorial herniation

Fig. 5

Midline shift in a patient with severe traumatic brain injury. The third ventricle appears as a hypoechoic band between two hyperechoic lines

Fig. 6

The circle of Willis, as scanned from a transtemporal approach in a patient who underwent a decompressive craniectomy. The different shapes of the arterial flows are shown in the picture

Fig. 7

The optic nerve sheath diameter can be measured using a transorbital approach

Fig. 8

An occipital approach to assess vertebral and basilar blood flow. Landmarks are the hyperechoic clivus and hypoechoic foramen magnum

Fig. 9

Reverberating flow in a patient with severe brain injury who developed an isoelectric encephalogram trace minutes after this recording and was confirmed brain dead a few hours later

Fig. 10

Devices commercially available for processed EEG monitoring

Fig. 11

Subcortical-cortical interactions

Fig. 12

Data delivered by processed EEG devices. A: SEDLine, Masimo Corp, Irvine, CA; B1 and B2: BIS, Medtronic, Boulder, CO. ASYM asymmetry, SEF spectral edge frequency, L left, R right