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Monitoring in neurointensive care

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The development of neurointensve care has had a huge impact on reducing the mortality in patients with critical neurologicalconditions. This neurointensive care includes mainly care for patients with traumatic brain injury., spinal cord injury, subarachnoid hemarrhage, intracranial haemorrhage and acute ...

The development of neurointensve care has had a huge impact on reducing the mortality in patients with critical neurologicalconditions. This neurointensive care includes mainly care for patients with traumatic brain injury., spinal cord injury, subarachnoid hemarrhage, intracranial haemorrhage and acute ischemic stroke. The acute injured brain is characterised by a primary and a secondary injury. Primary brain injury is the acute insult to the brain that can be ischemia, hemorrage, edema or trauma among others and is followed by secondary injuries.
The different types of primary injuries trigger secondary injury processes. The secondary injury processes can progress over hours, months and even years. Common pathways of neuronal death are posttraumatic ischemia, energy failure, excitotoxicity, mitochondrial failure, oxidative stress and release of free radicals, secondary cerebral swelling and inflammation. In parallel with these harmful processes, there are also an activation of neutrophins and growth factors that promote neuronal survival and plasticity occur.
The injured brain might also be subjected to secondary clinical insults e.g. high intracranial pressure, seizures, hypoxia, hypercapnia, hypocapnia, arterial hypotension, hyperthermia, hyperglycaemia, hypoglycaemia and hyponatremia. The secondary insults injure the vulnerable directly and initiate more secondary brain injury processes These secondary insults are also referred to as avoidable factors in clinical setting A great challenge for the treatment of patients with acute brain injury in the neurointensive care unit (NICU) is to detect early signs of secondary injuries in order to prevent further advancement and deterioration of the brain tissue. Multimodal monitoring including intracranial pressure (ICP), brain tissue oxygenation and microdialysis are widely used methods for detection of secondary events, in particular ischemia and metabolic disturbances. In addition, cerebral perfusion pressure and intracranial compliance are measured indirectly based on ICP monitoring. Further methods are trancranial doppler and EEG registering. All these continuous surveillance methods are either focal or global. Different noninvasive imaging techniques such as Xenon-CT and PET are been used to measure blood flow and metabolism across the whole brain. The imaging methods are intermittently used and provide snap shots of the injured brain. The information from the continuous focal and global monitoring techniques and the intermittent information obtained from the monitoring techniques are integrated to get the best picture of patients´ situation in order to guide treatment. The advancements provide potential approaches to more individualized therapeutic interventions.
Questions that need to be addressed are the relation of CBF and metabolic crises, are low CBF and metabolic crises signs if mitochondrial dysfunction rather than ischemia due to low CBF? How can we detect patients with acute brain insult at risk of developing ischemia in an early stage? Are there some patients that are more prone to bad outcome following secondary injuries due to their genetic background or premorbidity? How can we optimize neuromonitoring in neurointensive care? What are the potentials of information technology in standardizing data acquisition and analysis and integrating interpretation of multimodality neuromonitoring?
Scientist and clinician working with multimodal monitoring in neurointensive care are encouraged to contribute by submitting articles related to this research topic. Original research articles, review articles, clinical case studies, hypothesis and theory articles, method articles, opinion articles, or technology reports are welcomed.


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