Abstract
We have developed two monitoring systems, which we have applied to 78 critically ill patients in our neurosurgical intensive care unit. The first, a multidimensional neurological monitoring system employing a signal processor, serially and automatically monitors body temperature, auditory brainstem response (ABR), electroencephalographic power spectrum, intracranial pressure (ICP) and cerebral perfusion pressure (CPP). The second, which we have termed the cerebrosystemic hemodynamic profile, measures ICP, CPP, and ten other cardiovascular parameters. Using the multidimensional neurological monitoring system, we observed progressive loss of ABR waves in a case of brain death, transient prolongation of the wave V following a steep increase in ICP in a patient with a reruptured aneurysm, and gradual prolongation of ABR waves with an increase in ICP in a patient with transtentorial herniation.
This system comprehensively monitors supra- and infratentorial conditions and provides, in real time, objective information concerning pathophysiological processes within the cranium. The cerebrosystemic hemodynamic profile clearly delineates the optimal cardiovascular conditions for control of increased ICP, especially in the context of barbiturate therapy and severe fluid imbalance. Used in combination, these two monitoring systems may provide valuable guidance for treatment by virtue of their ability to accurately evaluate the pathophysiological processes that occur following severe brain damage.
