神経集中治療における脳機能モニタリングの進歩

抄録

In ER, prevalence of neurological illnesses which require neurocritical care is estimated to account for 40–60% of the patients. However, neuromonitoring is very limited compared to circulatory, respiratory, and other systems. Ideally, real–time neuromonitoring is needed, which is able to evaluate the brain function like blood pressure and blood oxygen saturation, regardless of time, place, specialty and condition of patients. The main goals of neuromonitoring in neurological illness and neurocritical care are to provide early detection of neurological worsening or cerebral dysfunction to avoid progression to irreversible neurological injury, better understand a patient's cerebral pathophysiology, and evaluate the effect of treatment. Evaluation of the pathophysiology of the critically ill patients with single monitoring is still difficult, thus combination of serial neurological examinations, neuroimaging studies, and continuous monitoring different neuropathophysiological parameters are inevitable. In this short review, we describe advances of neuromonitoring which include noninvasive intracranial pressure monitoring by transorbital ultrasonography, continuous and fast electroencephalogram monitoring with a novel electrode and headset, quantitative electric pupillometer, and endtidal CO₂ monitoring by capnometer.