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Table 3 Clinical application of neuromonitoring in the emergency department and intensive care unit

From: The Importance of Neuromonitoring in Non Brain Injured Patients

Setting

Neurological complications

Neuromonitoring

Evidence

Cardiac arrest

Neurological outcome

EEG or pEEG

Prognostication after cardiac arrest

Evoked

potentials

Prognostication after cardiac arrest (SSEPs) after 48–72 h

TCD

Detection of CBF abnormalities and intracranial hypertension

Pupillometry

Prognostication after cardiac arrest

Brain death

Diagnosis

EEG or pEGG

Electrocerebral silence

TCD

Detection of flow inversion, intracranial hypertension. Ancillary test

Pupillometry

No response

ECMO

Neurological outcome

EEG or pEGG

Prognostication in patients receiving ECMO

TCD

CBF alterations, stroke

NIRS

Association with neurological injury

ARDS and COVID-19

ARDS

Neurological complications, delirium

EEG or pEGG

Typical EEG includes abnormal background, epileptiform discharges in only 20%

TCD

Pulmonary shunt, microemboli, CBF alterations, cerebral autoregulation

NIRS

To detect brain deoxygenation, and responses to hemodynamic and respiratory maneuvers

Pupillometry

Inconclusive evidence

Liver diseases

Encephalopathy

TCD

High resistances on TCD, CBF alterations

NIRS

Association with outcome

Pupillometry

Pupillary abnormalities are associated with neurological complications

Kidney disease

Encephalopathy

TCD

CBF alterations

NIRS

Association with outcome

Sepsis

Encephalopathy

TCD

High resistances on TCD, altered CBF, high PI. Association between PI and delirium

NIRS

Association with outcome

Pupillometry

Pupillary abnormalities are associated with neurological complications

  1. EEG electroencephalogram, pEEG processed EEG, TCD transcranial Doppler, NIRS near infrared spectroscopy, BIS Bispectral index, rSO2 regional saturation of oxygen, SSEPs sensory evoked potentials, CBF cerebral blood flow, ICP intracranial pressure, PI pulsatility index, ARDS acute respiratory distress syndrome, COVID-19 coronavirus disease 2019, ECMO extracorporeal membrane oxygenation