Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Mar;90(3):261-271.
doi: 10.1007/s12098-022-04415-6. Epub 2023 Jan 6.

Multimodal Neuromonitoring in Pediatric Neurocritical Care: Current Perspectives

Affiliations
Review

Multimodal Neuromonitoring in Pediatric Neurocritical Care: Current Perspectives

Muthuvel R et al. Indian J Pediatr. 2023 Mar.

Abstract

Children with neurological illness in the critical care unit are always at higher risk of developing secondary brain injury (SBI). Brain insult can lead to changes in cerebral autoregulation, intracranial pressure (ICP), cerebral oxygenation, and metabolism. This can cause a raised ICP, cerebral ischemia, hypoxia, excitotoxicity, cellular energy failure, and nonconvulsive status epilepticus. Simultaneous and continuous assessment of these parameters will help to improve patient care and neurological outcomes. Even though clinical examination and neuroimaging can help in the initial diagnosis of the neurological illness, they may not be helpful in continuous monitoring of cerebral pathophysiological changes. The ideal single neuromonitoring device to detect these real-time changes is currently unavailable. However, a range of invasive and noninvasive monitors are available to monitor these cerebral functional parameters. Invasive monitoring techniques include invasive ICP monitoring, cerebral autoregulation monitoring, brain tissue partial oxygen pressure, and cerebral microdialysis. Noninvasive-monitoring techniques include pupillometry, brain and ocular ultrasonography, near-infrared spectroscopy, and electrophysiological monitoring. Multimodal (MM) neuromonitoring involves incorporating these techniques and tools for the early identification and treatment of primary and secondary brain insults. The utility and feasibility of most of these techniques are well described in adult neurocritical care. Even though the evidence on their usage in children is primarily available in pediatric traumatic brain injury, the emerging data help to further expand their utility in pediatric nontraumatic coma. MM neuromonitoring aims to provide clinical and pathophysiological information to the intensivists to improve their understanding of the child's neurological status and to formulate patient-specific treatment approaches.

Keywords: Multimodal monitoring; Neurocritical care; Nontraumatic coma; Raised ICP; Traumatic brain injury.

PubMed Disclaimer

Similar articles

References

    1. Fink EL, Kochanek PM, Tasker RC, et al. Prevalence of Acute critical Neurological disease in children: A Global Epidemiological Assessment (PANGEA) Investigators. International survey of critically ill children with acute neurologic insults: the prevalence of acute critical neurological disease in children: a global epidemiological assessment study. Pediatr Crit Care Med. 2017;18:330–42.
    1. Bansal A, Singhi SC, Singhi PD, Khandelwal N, Ramesh R. Non traumatic coma. Indian J Pediatr. 2005;72:467–73. - DOI - PubMed
    1. Kukreti V, Mohseni-Bod H, Drake J. Management of raised intracranial pressure in children with traumatic brain injury. J Pediatr Neurosci. 2014;9:207–15.
    1. Singhi S, Kumar R, Singhi P, Jayashree M, Bansal A. Bedside burr hole for intracranial pressure monitoring performed by pediatric intensivists in children with CNS infections in a resource limited setting: 10-y experience at a single center. Pediatr Crit Care Med. 2015;16:453–60. - DOI
    1. Bochicchio M, Latronico N, Zappa S, Beindorf A, Candiani A. Bedside burr hole for intracranial pressure monitoring performed by intensive care physicians. A 5 years experience. Intensive Care Med. 1996;22:1070–4.

LinkOut - more resources