Acute Brain Injury

The injured brain generally needs intensive treatment on the ICU. Due to anesthesia, monitoring of neurological signs is impossible; therefore, multi-parameter brain monitoring plays an important role. A recent exciting proposal is the monitoring of the so-called 'optimal CPP', the strategy which theoretically minimizes the risk of autoregulation failure.

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Clinical Research

Various procedures in clinical research require computer support. Newer applications include the assessment of dysautonomia in TBI and after SAH, the complexity of brain signals following acute brain injury, and in premature neonates, critical closing pressure in the neonatal intensive care unit, monitoring and analysis of spinal cord pressure, etc.

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CSF Disorders

Hydrocephalus and Idiopathic Intracranial Hypertension (IIH) often require invasive ICP monitoring in various stages of management. Fresh diagnosis is supported by infusion tests and/or overnight ICP monitoring. Assessment of the implanted shunt (if it under-drains or over-drains) is done via infusion study into the shunt pre-chamber, and in unsuitable cases, also overnight ICP monitoring. Both infusion tests and overnight ICP monitoring are supported in ICM+.

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Laboratory Applications

Multimodal monitoring in laboratory requires computer support. Various protocols in different centers have been used. Apart from classical signals like in TBI, monitors like laser Doppler flowmetry, rheoencephalography, NIRS, diffused correlation spectroscopy, etc., are verified. Various novel secondary indices can be designed and tested in an experimental environment.

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Neonatal

Preterm birth is associated with mortality and long-term disabilities. Despite the advances in neonatal medicine in the last 20 years, brain injury remains a burden for those infants who survive. Therefore, the main goal of optimising neonatal care and improving neurological outcome for preterm infants should be focused on early brain cot-side monitoring and neuroprotection. Non-invasive methods based on near-infrared spectroscopy (NIRS) brain monitoring can be used for optimising management, regarding the determination of optimal blood pressure, avoiding ischemia, or the risk of brain haemorrhage.

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Non-Invasive Brain Monitoring

Non-invasive indices are mainly based on TCD and NIRS monitoring. Multi-parametric TCD (in conjunction with arterial blood pressure) may include: autoregulation indices, non-invasive ICP and CPP, critical closing pressure, and the cerebrovascular time constant (TAU). NIRS is ideal for long-term, non-invasive monitoring of cerebral autoregulation.

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Stroke

Ischemic stroke affects blood flow in cerebral arteries. Techniques like TCD allow the calculation of various autoregulation indices and continuous assessment of critical closing pressure.

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