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Updated: Jul 23, 2025
A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients
Published on: October 17, 2017
A narrative review of neuromonitoring modalities in critically ill children
Abhinav Totapally1, Emily A Fretz1, Michael S Wolf2
1Division of Critical Care Medicine, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
Insights
Specialized neuromonitoring in critically ill children offers insights into brain injuries. These advanced techniques improve diagnosis, treatment, and prognosis for conditions like traumatic brain injury and meningitis.
Area of Science:
- Pediatric critical care medicine
- Neuroscience
- Medical technology
Background:
- Acute neurologic injury is prevalent in critically ill children.
- Conditions like traumatic brain injury, meningitis, and hypoxic-ischemic injury necessitate understanding cerebral physiology.
- Specialized neuromonitoring provides crucial patient- and disease-specific insights.
Purpose of the Study:
- To review recent innovations in invasive and noninvasive neuromonitoring techniques for critically ill children.
- To discuss the physiological mechanisms and clinical applications of these techniques.
- To explore the use of neuromonitoring in systemic illnesses like sepsis and cardiorespiratory failure.
Main Methods:
- Review of current literature on invasive (intracranial pressure monitoring) and noninvasive (transcranial doppler, near-infrared spectroscopy) neuromonitoring.
- Discussion of physiological principles interrogated by each technique.
- Analysis of evidence for clinical application in pediatric neurocritical care.
Main Results:
- Innovations in intracranial pressure monitoring offer computed indices for better assessment.
- Noninvasive techniques like transcranial doppler and near-infrared spectroscopy provide valuable data.
- Neuromonitoring aids in managing neurologic complications in sepsis and extracorporeal membrane oxygenation contexts.
Conclusions:
- Advanced neuromonitoring techniques are vital for improving outcomes in pediatric neurocritical care.
- These methods enhance diagnostic accuracy, guide therapeutic interventions, and inform prognosis.
- Further research and integration of these technologies are warranted for broader clinical application.
Abstract:
Acute neurologic injury is common in critically ill children. Some conditions - such as traumatic brain injury, meningitis, and hypoxic-ischemic injury following cardiac arrest - require careful consideration of cerebral physiology. Specialized neuromonitoring techniques provide insight regarding patient-specific and disease-specific insight that can improve diagnostic accuracy, aid in targeting therapeutic interventions, and provide prognostic information. In this review, we will discuss recent innovations in invasive (e.g., intracranial pressure monitoring and related computed indices) and noninvasive (e.g., transcranial doppler, near-infrared spectroscopy) neuromonitoring techniques used in traumatic brain injury, central nervous system infections, and after cardiac arrest. We will discuss the pertinent physiological mechanisms interrogated by each technique and discuss available evidence for potential clinical application. We will also discuss the use of innovative neuromonitoring techniques to detect and manage neurologic complications in critically ill children with systemic illness, focusing on sepsis and cardiorespiratory failure requiring extracorporeal membrane oxygenation.
