Neuromonitoring: an overview

Area of Science:

• Neuroscience
• Critical Care Medicine
• Neurology

Background:

• Acute brain injury is a major cause of ICU admission and long-term disability.
• Clinical neurological exams are often limited in sedated, ventilated patients.
• Intracranial pressure (ICP) alone is insufficient for understanding secondary brain injury.

Purpose of the Study:

• To review current neuromonitoring techniques used in neurocritical care.
• To describe the physiological basis, evidence, indications, and limitations of each technique.
• To highlight the shift towards multimodal neuromonitoring.

Main Methods:

• Narrative review of neuromonitoring techniques.
• Systematic addressal of invasive ICP monitoring, non-invasive methods, cerebral perfusion assessment, oxygenation monitoring, cerebral microdialysis, and neurophysiological techniques.
• Discussion of physiological rationale, evidence, clinical indications, and limitations.

Main Results:

• Multimodal neuromonitoring strategies are increasingly adopted in neurocritical care.
• Evidence supporting these modalities is largely based on observational studies and expert consensus, with limited randomized trials.
• Individualized, goal-directed frameworks integrating complementary monitors are the current standard.

Conclusions:

• Advanced neurocritical care relies on multimodal neuromonitoring beyond basic ICP.
• Integrating various monitoring techniques provides a more complete picture of brain pathophysiology.
• Individualized application of these monitors is key to effective management.