Monitoreo neurológico multimodal en cuidado intensivo

Abstract

There are multiple monitoring strategies for the follow-up of patients with brain injuries admitted to the intensive care unit (ICU). These strategies begin with a neurological assessment, include imaging studies, and culminate with the implementation of cutting-edge, high-definition technologies. Clinical outcomes depend on the interpretation of the generated data. Neuromonitoring has received increasing attention in recent years. Current scientific evidence recommends practice standards for the use of neuromonitoring in critically ill patients, emphasizing the need to standardize technologies, efforts, and training necessary to integrate and interpret information from multimodal neuromonitoring (NMM). The future of neuromonitoring is oriented towards the integration and innovation of invasive and non-invasive NMM techniques. In terms of intracranial pressure (ICP), monitoring with an intraventricular catheter remains the reference technique or gold standard. Additionally, technologies for measuring cerebral oxygenation, ultrasonographic evaluations such as transcranial Doppler, optic nerve sheath measurement, and emerging techniques such as automated pupillometry and near-infrared spectroscopy (NIRS), should motivate intensivists to understand their foundation and interpretation, as well as their application to generate treatment strategies, monitor them, and impact better clinical outcomes. This review offers an updated assessment of the status of various neuromonitoring modalities and their use in different scenarios, highlighting the advantages and limitations of each method for implementation, emphasizing their utility in the ICU.