ABSTRACT
Monitoring of cerebral physiology and metabolism within the moderate-to-severe traumatic brain injury (TBI) patient population is challenging. Various techniques exist, probing specific aspects of cerebral physiology. The chapter focuses on highlighting the main techniques described within the current literature. Commonly used monitoring modalities include: Intracranial pressure (ICP)―invasive and noninvasive, transcranial Doppler (TCD) sonography, near infrared spectroscopy (NIRS), cerebral blood flow (CBF) monitoring―intermittent and continuous methods, brain tissue oxygen (PbtO2), jugular venous oxygen saturation (SjvO2), cerebral microdialysis (CMD), imaging-based metabolism, autonomics, brain temperature, and continuous cortical electrophysiology (electroencephalography and evoked potentials). The aspects of monitored physiology include: ICP, cerebral perfusion pressure (CPP), cerebral autoregulation (CA), cerebrovascular reactivity (CVR), CBF (regional/global), tissue oxygen diffusibility (PbtO2), oxygen extraction and metabolism (SvjO2 and NIRS), regional cerebral metabolism (CMD)/global cerebral metabolism (imaging), heart rate variability (HRV)/baroreceptor response (BRS), brain temperature, continuous EEG, spreading cortical depression, somatosensory evoked potentials, motor evoked potentials, and parent signal entropy. All aspects of monitoring described provided novel insight into various aspects of physiology/metabolism. Future work will be focused on collection, analysis, and interpretation of complex data sets derived from multi-modal monitoring, leading to improved predictive modelling and avenues for intervention for secondary brain injury post-TBI.
