New approaches to physiological informatics in neurocritical care

A fundamental purpose of neurocritical care is the management of secondary brain injury. This is often accomplished by monitoring and managing individual patient parameters including physiological vital signs. Yet, the ability to record physiological data exceeds our ability to fully integrate it into patient care. We propose that advances in monitoring must be accompanied by advances in methods of high-frequency, multivariate data analysis that integrate the multiple processes occurring in critically ill patients.

We describe initial work in the emerging field of physiological informatics in critical care medicine. We analyzed data on 23 patients with brain injury from our Neurotrauma and Critical Care Database, which contains more than 20 physiological parameters recorded automatically at one-minute intervals via bedside monitors connected to standard personal computers. We performed exploratory data analysis, studied two patient cases in detail, and implemented a data-driven classification approach using hierarchical clustering.

In this study, we present challenges and opportunities for high-frequency multimodal monitoring to quantitatively detect secondary brain insults, and develop clustering methodology to construct multivariate physiological data "profiles" to classify patients for diagnosis and treatment.

Recording of many physiological variables across multiple patients is feasible and can lead to new clinical insights. Computational and analytical methods previously used primarily for basic science may have clinical relevance and can potentially be adapted to provide physicians with improved ability to integrate complex information for decision making in neurocritical care.