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• W1530836740 abstract "Multimodality neuromonitoring has became increasingly complex, and although advances in neuromonitoring have provided insight into pathophysiology and physiological response to therapy, beneficial effects on patient outcomes have not been definitively established. The attitude towards the benefits of monitoring equipment has often been guided by wishful thinking. Rosner and colleague (Rosner MJ,1986) popularized the notion that cerebral perfusion pressure (CPP) should be aggressively managed at levels above 70-90 mmHg, if necessary by using vasopressors. At the same time, however, the “Lund concept” urged for a reduction of microvascular hydrostatic pressures to minimize oedema formation, accepting CPP as low as 50 mmHg in adults (Grande PO,2002 ). Following an update of the Brain Trauma Foundation guidelines in 2003, the consensus target value for CPP has been set at 60 mmHg. Even so, the controversy described above exemplifies the frustrating lack of good evidence that is available to make rational treatment decisions in the setting of intracranial pressure (ICP)-guide care. It is important to consider that there is large heterogeneity within the head trauma population, the intracerebral hemorrhage, the subarachnoid hemorrhage and the physiopathology between them. Therefore it is possible that many commonly used interventions that are aimed to reduce intracranial hypertension are ineffective, unnecessary or even harmful for some patient at certain times, at certain values. There is an increasing awareness that an aggressive ICP and CPP targeted approach may result in cardiorespiratory complications. A key limitation in the demonstration of efficacy of monitoring in neurocritical care is the complexity of care generated by multimodality monitoring. If one considers continuously monitoring 10-20 interrelated physiological parameters in a modern neurocritical care unit and each parameter has 10 possible interventions, the enormous potential number of co-interventions represents a formidable challenge in clinical trial design. The application of continuous neurophysiological monitoring with somatosensory evoked potential (SEP) and electroencephalography (EEG) have an intuitive appeal, since these techniques yeald a direct measure of brain function in patients whose neurological status might otherwise be difficult to evaluate. The early components of SEP are used in the acute phase of cerebral damage when the patient, as result of sedatives, neuromuscular blockade or the severity of coma, is difficult to assess on a clinical level. Short latency SEP are largely resistant to analgo-sedation and have a waveform, which is easily interpretable and comparable in subsequent recordings. They have peripheral, spinal, brainstem and intracortical components, which are identifiable in all subject exploring an extended Cerebral Nervous" @default.
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• W1530836740 date "2012-03-16" @default.
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• W1530836740 title "Dynamic Brain Function Monitoring a New Concept in Neuro-Intensive Care" @default.
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• W1530836740 doi "https://doi.org/10.5772/37237" @default.
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