Multi-modal monitoring for malignant cerebral edema, increased ICP, and other conditions is rapidly gaining favor amongst our Neurological ICU and Neurosurgery community. Thus far, no standard of care has been established. And the data collected from intracranial device monitors such as the Licox and depth electrode EEGs have variable clinical significance. Regardless, the trend will likely continue.
A host of new devices now promise use of infrared and other technology for noninvasive multi-modal monitoring. If proven with accuracy, this would not only be superior to intracranial monitors due to lack of infections and other concerns, but could also being this possibility to a host of patients who have contraindications to or do not want neurological surgery.
I am curious what devices you are using at your institutions and how has your experience been so far? Specifically, do you feel the noninvasive device is as accurate as the current intracranial devices and do you have data correlating the two to affirm this?
New tools have been added to the clinical, laboratory, neurophysiological and neurosonological arsenal in the multiparameter monitoring of neurological patients and an interesting technique is the non-invasive assessment of brain compliance. (more information in brain4care)
Transcranial Doppler. I and my colleagues are carrying out multi-institutional Phase III Clinical Trial on determining the efficacy of TCD among patients with subarachnoid hemorrhage and traumatic brain injury. Hopefully it can better answer this highly important question.
We also carried out a related meta-analysis:
Fatima N, Shuaib A, Chughtai TS, Ayyad A, Saqqur M. The Role of Transcranial Doppler in Traumatic Brain Injury: A Systemic Review and Meta-Analysis. Asian J Neurosurg. 2019;14(3):626-633. doi:10.4103/ajns.AJNS_42_19
We are using Trans cranial doppler to assess cerebral edema and studying USG assessment of optic nerve diameter and comparing and validating this with MRI brain. Lots of data are yet required to validate it.
What about non invasive CSF pressure monitoring.
Also invasive monitoring in case a patient is on a ventilator: how do you judge the readings in this setting?
Dr Otto,
Kindly talk more about non-invasive assessment of brain compliance.
I prefer your personal talk more than looking to papers. What are the range of benefits of this test.
Thanks in advance to all of you.
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