Brainstem Monitoring in the Neurocritical Care Unit: A Rationale for Real-Time, Automated Neurophysiological...

Area of Science:

• Neuroscience
• Critical Care Medicine
• Neurophysiology

Background:

• Altered mental status in severe traumatic brain injury and intracranial lesions often indicates brain herniation.
• Current monitoring methods like neurological exams and intracranial pressure monitoring have limitations.
• There is a need for practical, noninvasive, real-time bedside monitoring of neurophysiological function.

Purpose of the Study:

• To review the ascending arousal system and brain herniation mechanisms.
• To highlight the shortcomings of current management strategies for brain injury.
• To propose the development of continuous, automated, alarmed evoked potential monitoring.

Main Methods:

• Critical review of clinical and experimental literature.
• Analysis of advances in prognostication of cerebral anoxia.
• Examination of intraoperative neurophysiological monitoring techniques.

Main Results:

• Current bedside monitoring for brainstem and cerebral function is limited.
• Evoked potential monitoring offers a potential solution for continuous assessment.
• Automated and alarmed systems could enhance clinical management.

Conclusions:

• There is a critical need for improved bedside neurophysiological monitoring in neurocritical care.
• Automated evoked potential monitoring presents a promising avenue for real-time assessment.
• This technology could enhance patient management and prognostication in severe brain injury.