Multimodal neurological monitoring in neurotrauma

Multimodal neuromonitoring is used as an adjunct to clinical neurological examination, imaging and other diagnostic studies to obtain the most detailed information about the physiology of the brain. Neuromonitoring has been a standard of care for patients presenting with traumatic brain injury in most critical care centres for the past several years. Neuromonitoring is composed of multiple variables, which not only provides a better dynamic of the pathophysiology of the compromised brain but also how it might respond to the corresponding management procedures. Although the clinical neurological examination is the standard for monitoring the neurocritical patient, the results obtained in the latter may be insufficient or inconclusive to detect or prevent secondary brain injury. Therefore, multiple neuromonitoring tools have been developed to measure different physiological variables that can contribute to a better follow-up of patients with traumatic brain injury. These variables include cerebral blood flow, cerebral electrical activity, cerebral metabolism, cerebral oxygenation and cerebral pressure. Thanks to monitoring as an adjuvant in critical care, it has been possible to avoid, identify and manage secondary brain injuries that commonly aggravate patients. This review aims to illustrate the main advantages and most recent recommendations regarding neuromonitoring based on the most current evidence.