Menon Lecture
Monitoring the brain: beyond ICP
Professor David K Menon, Cambridge
/resources/1/videos/davidmenon 2009.flv
Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) have formed the bedrock of neurocritical care monitoring and therapy targeting for the last two decades. While most retrospective analyses of the use of such clinical paradigms suggest clear benefit, there are occasional studies that suggest harm from these approaches. Further, there are no Class I clinical trial data supporting the use of this approach in the context of traumatic brain injury (TBI). Even amongst enthusiasts of CPP based management of TBI, there is a growing realization that physiological targets that are developed based on population averages may not provide the ideal context in which to plan the optimal management of TBI in individuals. Several approaches have been described to refine CPP targets in individual subjects. One has been to use signal processing techniques to derive relationships amongst monitored variables that characterize the physiological status of the patient. A second, growing approach has been to use data provided by several ancillary monitoring techniques (such as brain oximetry, transcranial Doppler ultrasound, and microdialysis) to better understand the specific pathophysiological events that are responsible for worse outcomes. Finally, some centres have used physiological imaging to understand variations in pathophysiology between subjects, over time, and within different parts of the injured brain. This talk will explore the ways in which we might use these approaches to individualise management and improve outcome after TBI.