Neuromonitoring in the Intensive Care Unit for Treatment and Prognostication

The critically ill neurologic patient is complex and often their disease process has adverse effects not only on the nervous system but also the cardiopulmonary system. Studies have shown improved outcomes and decreased length of intensive care unit (ICU) stay for patients treated in a dedicated neurologic intensive care unit (Neuro ICU), likely secondary to specialized nursing care, neurointensivist teams, and protocolized management of complex neurologic illness. When it comes to monitoring a patient in the Neuro ICU, there is a wide variety of tools and parameters we record to help guide treatment plans and communicate prognostic information to patients and families. Some examples of neuromonitoring typically performed in a Neuro ICU include intracranial pressure (ICP), cerebral perfusion pressure (CPP), transcranial Doppler (TCD), electroencephalograms (EEGs), brain tissue oxygenation, and pupillometry. The purpose of monitoring patients in the neurocritical care unit is to detect, prevent, and treat reversible causes of further brain injury. In our patient population, this information is often complicated, and misinterpretation can lead to inaccurate diagnosis and treatment. In this chapter, we discuss how the data we collect can be translated to the clinical context with some case presentations to exemplify the complexities of monitoring and managing patients with severe neurologic disease.