Monitoring of neurocritical care: Part 1

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Neurocritical Care Monitoring Chad M. Miller • Michel T. Torbey Neurocritical Care Monitoring Neurocritical Care Monitoring Editors Chad M. Miller, MD Associate Professor of Neurology and Neurosurgery Wexner Medical Center Ohio State University Columbus, Ohio Michel T. Torbey, MD Professor of Neurology and Neurosurgery Director, Division of Cerebrovascular Diseases and Neurocritical Care Wexner Medical Center Ohio State University Columbus, Ohio Visit our website at www.demosmedical.com ISBN: 9781620700259 e-book ISBN: 9781617051883 Acquisitions Editor: Beth Barry Compositor: Integra Software Services Pvt. Ltd. © 2015 Demos Medical Publishing, LLC. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher. Medicine is an ever-changing science. Research and clinical experience are continually expanding our knowledge, in particular our understanding of proper treatment and drug therapy. The authors, editors, and publisher have made every effort to ensure that all information in this book is in accordance with the state of knowledge at the time of production of the book. Nevertheless, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the contents of the publication. Every reader should examine carefully the package inserts accompanying each drug and should carefully check whether the dosage schedules mentioned therein or the contraindications stated by the manufacturer differ from the statements made in this book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. Library of Congress Cataloging-in-Publication Data Neurocritical care monitoring / editors, Chad M. Miller, Michel T. Torbey. p. ; cm. Includes bibliographical references and index. ISBN 978-1-62070-025-9 (alk. paper) -- ISBN 978-1-61705-188-3 (e-book) I. Miller, Chad M., editor. II. Torbey, Michel T., editor. [DNLM: 1. Central Nervous System Diseases--diagnosis. 2. Neurophysiological Monitoring. 3. Critical   ­Care--methods. 4. Nervous System Physiological Phenomena. WL 141]   RC350.N49   616.8’0428--dc23 Proudly sourced and uploaded by [StormRG] Kickass Torrents | TPB | ExtraTorrent | h33t 2014032210 Special discounts on bulk quantities of Demos Medical Publishing books are available to corporations, professional associations, pharmaceutical companies, health care organizations, and other qualifying groups. For details, please contact: Special Sales Department Demos Medical Publishing, LLC 11 West 42nd Street, 15th Floor New York, NY 10036 Phone: 800-532-8663 or 212-683-0072 Fax: 212-941-7842 E-mail: specialsales@demosmedical.com Printed in the United States of America by Bradford and Bigelow. 14 15 16 17 / 5 4 3 2 1 Contents Contributors  vii Foreword  J. Claude Hemphill III, MD, MAS, FNCS  ix Preface  xi Share Neurocritical Care Monitoring 1. Intracranial Pressure Monitoring   1 Nessim Amin, MBBS and Diana Greene-Chandos, MD 2. Transcranial Doppler Monitoring   18 Maher Saqqur, MD, MPH, FRCPC, David Zygun, MD, MSc, FRCPC, Andrew Demchuk, MD, FRCPC and Herbert Alejandro A. Manosalva, MD 3. Continuous EEG Monitoring   35 Jeremy T. Ragland, MD and Jan Claassen, MD, PhD 4. Cerebral Oxygenation   50 Michel T. Torbey, MD and Chad M. Miller, MD 5. Brain Tissue Perfusion Monitoring   59 David M. Panczykowski, MD and Lori Shutter, MD 6. Cerebral Microdialysis   70 Chad M. Miller, MD 7. Cerebral Autoregulation   85 Marek Czosnyka, PhD and Enrique Carrero Cardenal, PhD 8. Neuroimaging  102 Latisha K. Ali, MD and David S. Liebeskind, MD v vi ■ Contents 9. Evoked Potentials in Neurocritical Care   124 Wei Xiong, MD, Matthew Eccher, MD, MSPH and Romergryko Geocadin, MD 10. Bioinformatics for Multimodal Monitoring   135 J. Michael Schmidt, PhD, MSc 11. Nursing: The Essential Piece to Successful Neuromonitoring   145 Tess Slazinski, RN, MN, CCRN, CNRN, CCNS 12. Multimodal Monitoring: Challenges in Implementation and Clinical Utilization   159 Chad M. Miller, MD Index  167 Contributors Latisha K. Ali, MD Assistant Professor, Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, California Nessim Amin, MBBS Fellow of Neurosciences Critical Care, Departments of Neurological Surgery and Neurology, Wexner Medical Center, Ohio State University, Columbus, Ohio Enrique Carrero Cardenal, PhD Professor, Department of Anesthesiology, Hospital Clinic, University of Barcelona, Barcelona, Spain Jan Claassen, MD, PhD Assistant Professor of Neurology and Neurosurgery, Director, Neurocritical Care Training Program, New York Presbyterian Hospital, Division of Critical Care Neurology, Columbia University College of Physicians and Surgeons, New York, New York Marek Czosnyka, PhD Professor, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom Andrew Demchuk, MD, FRCPC Associate Professor, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada Matthew Eccher, MD, MSPH Assistant Professor of Neurology and Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, Ohio Romergryko Geocadin, MD Associate Professor, Department of Anesthesiology and Critical Care Medicine, Department of Neurology, Department of Neurosurgery, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland vii viii ■ Contributors Diana Greene-Chandos, MD Director of Education, Quality and Outreach for Neurosciences Critical Care, Wexner Medical Center, Ohio State University, Columbus, Ohio David S. Liebeskind, MD Assistant Professor, Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, California Herbert Alejandro A. Manosalva, MD Fellow in Cerebrovascular Diseases, Movement Disorders and Neurogenetics, Department of Neurology, University of Alberta, Edmonton, Canada Chad M. Miller, MD Associate Professor of Neurology and Neurosurgery, Wexner Medical Center, Ohio State University, Columbus, Ohio David M. Panczykowski, MD Resident, Neurological Surgery, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Jeremy T. Ragland, MD Fellow, Division of Neurocritical Care, Department of Neurology, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital/Columbia University Medical Center, New York, New York Maher Saqqur, MD, MPH, FRCPC Associate Professor, Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Alberta, Canada J. Michael Schmidt, PhD, MSc Assistant Professor of Clinical Neuropsychology in Neurology, Informatics Director, Neurological Intensive Care Unit, Critical Care Neuromonitoring, Columbia University College of Physicians and Surgeons, New York, New York Lori Shutter, MD Co-Director, Neurovascular ICU, UPMC Presbyterian Hospital, Director, Neurocritical Care Fellowship, Departments of Neurology, Neurosurgery, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Tess Slazinski, RN, MN, CCRN, CNRN, CCNS Los Angeles, California Cedars Sinai Medical Center, Michel T. Torbey, MD Professor of Neurology and Neurosurgery, Director, Division of Cerebrovascular Diseases and Neurocritical Care, Wexner Medical Center, Ohio State University, Columbus, Ohio Wei Xiong, MD Assistant Professor of Neurology, Neurointensivist, Case Western Reserve University School of Medicine, Cleveland, Ohio David Zygun, MD, MSc, FRCPC Professor and Divisional Director, Departments of Critical Care Medicine, Clinical Neurosciences, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada Foreword When I was considering going into neurocritical care over 20 years ago, it was in large part because of an interest in the physiology (as opposed to anatomy) of acute brain catastrophes (my term), and optimism that intervention must be possible. Patients in the pulmonary and cardiac intensive care units were active, and my colleagues routinely made treatment changes many times a day based on the physiology of the patient’s condition, a physiology that was identified by a monitor such as a flow-volume loop on the ventilator in an acute respiratory distress syndrome (ARDS) patient or a pulmonary-artery catheter in a patient with cardiogenic shock. As a neurology resident in an era when neurocritical care as a distinct discipline existed in very few places (my center was not one), it was interesting to watch general intensivists and neurologists alike walk past comatose patients, document an unchanged neurologic examination, declare them stable, and move on. Something nagged at me that these patients were also suffering from “active” conditions that deserved intervention. Many had suffered traumatic brain injury, ischemic stroke, intracerebral hemorrhage, and the like; if we would only identify the target, we could offer them the same level of care. Sure, we had intracranial pressure monitoring and transcranial Doppler. I remember hearing about media reports of Dr. Randy Chesnut, who was pushing the concept that monitoring “the brain pressure” was important. We also had data from the Traumatic Coma Data Bank and Stroke Data Bank that suggested secondary brain insults were real and impacted our patients’ outcomes. The Brain Trauma Foundation Severe Head Injury Guidelines had not yet been published, the NINDS IV t-PA study was ongoing, and the idea of directly measuring cerebral metabolism in real time made sense, but I (and my colleagues) had no idea how we might do it. Emboldened by the huge advances in basic and translational science in the 1980s and early 1990s that allowed understanding of the cellular mechanisms of acute ischemia and brain trauma, I realized that my patients were, in fact, undergoing active and potentially interveneable processes. The issue was now how to track these events and what to do. ix
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