ABSTRACT

Neurotrauma is a complex syndrome characterized by different pathophysiologic processes leading to raising intracranial pressure (ICP), alteration of cerebral blood flow (CBF), and neuroinflammation. In this view, multimodal monitoring is essential to tailoring therapies to specific pathophysiologic processes. Intensive Care Unit (ICU) management is based on general intensive interventions to preserve systemic homeostasis, and specialized neurologic care that has the following goals: intracranial volume control, optimization of cerebral oxygen supply and demand, and maintenance of cerebral homeostasis. ICP control needs a stepwise approach, from analgesia and sedation to hyperventilation and hypothermia. In neurotrauma, it is crucial to preserve CBF through evaluation of the patient’s autoregulation and identification of best cerebral perfusion threshold. Advanced monitoring of cerebral oxygen metabolism rate (CMRO2), through jugular venous bulb oximetry (SjO2), the measurement of the brain oxygen tissue tension (PbtO2), and microdialysis that evaluates cerebral metabolism, are useful in the management of cerebral energy dysfunction. Currently, there are no effective neuroprotective agents that act on neurotrauma. Given the complexity of neurotrauma pathophysiology, ICU neurologic care of this syndrome has to target every therapeutic intervention to patient-specific pathophysiology rather than to predefined thresholds.