Intracranial monitoring

The critical care management of patients who have suffered catastrophic neurological injuries such as intracerebral hemorrhage, traumatic brain injury, ischemic stroke and subarachnoid hemorrhage has undergone significant advances in the last few decades. The intensivist caring for these patients now has a full armamentarium of invasive and noninvasive monitoring techniques for gathering real-time information regarding the physiology and metabolism of the injured brain in patients who are comatose, rendering the neurological examination unreliable or incomplete. The monitoring techniques available today in the ICU allow for measurement of intracranial pressure (ICP), cerebral perfusion pressure (CPP), cerebral blood flow (CBF), oxygenation, temperature, cerebral cellular metabolism, and, most recently, intracortical electroencephalography. The data yielded from intracranial monitoring in this subset of critically ill patients provides information down to the cellular level, helping to guide management and improve outcomes.¹, ²