Advanced neuromonitoring techniques for medical and neurological ICU patients

Abstract

Newly developed neurological complications are not confined to patients admitted to the neurology ICU but also occur in the medical ICU. In addition to patients with traumatic brain injuries, critically ill patients with sepsis, encephalopathy, and post-cardiopulmonary resuscitation are at risk of developing neurological complications. The situation can worsen when patients are sedated and intubated, which prevents the clinical manifestations to be presented. In this regard, non-convulsive seizures and status epilepticus, new onset strokes, and neuromuscular weakness syndromes could be missed which escalates the prognosis. The advancement of neuromonitoring technology enables real-time, multimodal assessments of brain functions, improving the ability of clinicians to detect and preemptively address potential neurological complications. In this study, we reviewed which certain neurological and medical conditions pose a high risk for developing secondary or new-onset neurological complications. Additionally, we reviewed various approaches that can assist in detecting these complications, including automated pupillometry, Bispectral Index monitoring, electroencephalogram, somatosensory evoked potentials monitoring, jugular venous oxygen saturation monitoring, PbO2 monitoring, near-infrared spectroscopy, transcranial Doppler sonography, thermal diffusion flowmetry, cerebral perfusion pressure monitoring, and biomarkers associated with neuronal damage. Last but not least, we reviewed the potential of integrating artificial intelligence in the ICU.