ABSTRACT
Based on extensive experience in experimental models ( 1-4 ), invasive multimodal monitoring was introduced into neurointensive care of patients with severe disorders of the brain, especially in those with severe head injury ( 5,6 ). In these patients, repetitive or continuous recordings of brain tissue oxygenation, substrate delivery and concentration (e.g., glucose, lactate, pyruvate, and amino acids), and alterations of the ionic homeostasis supplement the established monitoring of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) ( 5,7-11 ). Because progressive interruption of substrate delivery, which affects patients after severe head injury, is also the main factor for tissue damage in subarachnoid hemorrhage (SAH), multimodal neuroimaging was also utilized to predict the development of brain damage, such as infarction or brain swelling ( 12-14 ). Recently, multimodal neuromonitoring was also introduced into the management of patients with acute ischemic stroke ( 15 ), especially aiming at an early prediction of development of space-occupying edema (malignant infarction) ( 16 ) and at an online assessment of treatment effects. This application of neuromonitoring represents a valid example of translational research, as variables determined in experimental models of focal ischemia can be compared to those obtained in patients with acute ischemic stroke.
