Department of Neurosurgery, Perelman School of Medicine; and.
Department of Neurology, Division of Neurocritical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Neurosurg Focus. 2017 Nov;43(5):E4. doi: 10.3171/2017.8.FOCUS17449.
Acute brain injuries are a major cause of death and disability worldwide. Survivors of life-threatening brain injury often face a lifetime of dependent care, and novel approaches that improve outcome are sorely needed. A delayed cascade of brain damage, termed secondary injury, occurs hours to days and even weeks after the initial insult. This delayed phase of injury provides a crucial window for therapeutic interventions that could limit brain damage and improve outcome. A major barrier in the ability to prevent and treat secondary injury is that physicians are often unable to target therapies to patients' unique cerebral physiological disruptions. Invasive neuromonitoring with multiple complementary physiological monitors can provide useful information to enable this tailored, precision approach to care. However, integrating the multiple streams of time-varying data is challenging and often not possible during routine bedside assessment. The authors review and discuss the principles and evidence underlying several widely used invasive neuromonitors. They also provide a framework for integrating data for clinical decision making and discuss future developments in informatics that may allow new treatment paradigms to be developed.
急性脑损伤是全球范围内导致死亡和残疾的主要原因。危及生命的脑损伤幸存者通常需要终身依赖护理，迫切需要新的方法来改善预后。在初始损伤后数小时到数天，甚至数周，会发生一系列称为继发性损伤的延迟性脑损伤。这种损伤的延迟阶段为治疗干预提供了一个关键窗口，可能会限制脑损伤并改善预后。预防和治疗继发性损伤的主要障碍是，医生通常无法将治疗方法针对患者独特的大脑生理紊乱。通过使用多种互补的生理监测仪进行有创神经监测，可以提供有用的信息，从而实现这种定制的、精准的护理方法。然而，整合多个随时间变化的数据流具有挑战性，并且在常规床边评估期间通常无法实现。作者回顾和讨论了几种广泛使用的有创神经监测器的原理和证据。他们还为临床决策制定提供了一个整合数据的框架，并讨论了信息学的未来发展，这些发展可能允许开发新的治疗模式。
