Was gibt es Neues zum Thema invasives Neuromonitoring?

Zusammenfassung

Die Überwachung der strukturellen und funktionellen Integrität des Zentralnervensystems und die Vermeidung von sekundären zerebralen Schäden stehen im Mittelpunkt der neurointensivmedizinischen Behandlung. Obwohl die engmaschige klinische Untersuchung hierbei eine zentrale Rolle spielt, sind der Beurteilbarkeit schwer betroffener analgosedierter und beatmeter Patienten Grenzen gesetzt. Bildgebende Verfahren erlauben die Darstellung struktureller Schäden und einiger funktioneller Parameter wie z. B. der zerebralen Perfusion, sind jedoch nur diskontinuierlich und mit einem verhältnismäßig großen personellen und apparativen Aufwand durchführbar. Vor diesem Hintergrund wurde eine Reihe invasiver apparativer Monitoringverfahren entwickelt, die kontinuierlich oder zumindest sehr engmaschig einen Einblick in die Veränderungen des intrakraniellen Drucks, des Sauerstoffpartialdrucks im Gehirn, des zerebralen Blutflusses, oder verschiedener metabolischer Parameter erlauben. Die vorliegende Übersicht fasst die relevanten sekundären Schädigungsmechanismen in Kürze zusammen und widmet sich im Wesentlichen der Darstellung verschiedener invasiver Neuromonitoring-Verfahren inklusive der aktuellen Datenlage aus klinischen Studien. Die praktische Relevanz des invasiven Neuromonitorings wird an Hand der aktuell veröffentlichten Konsensus-Empfehlungen, der internationalen multidisziplinären Kollaboration intensivmedizinischer Fachgesellschaften, vorgestellt.

Abstract

The evaluation of structural and functional integrity of the central nervous system, and prevention of secondary brain damage represents the main aim of neurocritical care. Clinical examinations are central to the management of severely injured sedated and ventilated patients, yet the value of clinical assessment is often very limited. Imaging modalities allow quantitation of structural damage and functional parameters, such a cerebral perfusion, but can only be carried out discontinuously and require great instrumental as well as personnel effort. In light of these difficulties, invasive monitoring devices have been developed, which allow continuous or at least highly frequent evaluation of changes in intracranial pressure, cerebral tissue oxygen, cerebral blood flow, and several metabolic parameters. The present review briefly summarizes the relevant mechanisms of secondary brain injury, focusing on invasive neuromonitoring techniques including available data from recent investigations. Moreover, the practical relevance of invasive neuromonitoring will be presented based on the recently published consensus statement of the international multidisciplinary collaboration of intensive care societies.

Schlüsselwörter

Neuromonitoring - multimodales Monitoring - zerebrale Parenchymsonden - Schlaganfall - Schädel-Hirn-Trauma

Keywords

neuromonitoring - multimodal monitoring - cerebral parenchymal probes - stroke - traumatic-brain injury

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