Essential Noninvasive Multimodality Neuromonitoring for the Critically Ill Patient.

Through the years, technology has evolved rapidly, along with great developments in medical devices, particularly in the field of neurointensive care. This has allowed us to delve into new levels of detail and precision, which would not be possible with clinical examination alone. Pupillary reflexes, for example, carry considerable weight on prognostication of the brain-injured patient, yet assessment is of a poor quality. With automated infrared pupillometry now available, clinicians are able to assess this reflex quantitatively. Brain ultrasound, developing from transcranial Doppler into transcranial color-coded duplex Doppler ultrasonography, has become of paramount importance in the assessment of intracranial blood flow, early diagnosis of vasospasm, and estimation of cerebral perfusion pressure and intracranial pressure. Moreover, B-mode can enable the physician to visualize space-occupying lesions such as hematomas and midline shift and to monitor the effectiveness of brain-protective medical interventions. Electroencephalography (EEG) is a complex field, and too few intensivists are able to apply it. However, its diagnostic potential for seizures, depth of sedation evaluation, and need for analgesia remains unparalleled. More simple forms of cerebral function monitoring technology can now provide a more simplified version of EEG, allowing us to titrate sedation and analgesia and diagnose subclinical seizure activity during anesthesia or in the ICU. In this chapter, we propose what we consider as essential noninvasive multimodality neuromonitoring.