Neuromonitoring in the ICU

Patient Selection and Monitoring Components

The American College of Critical Care Medicine recommends neuromonitoring for critically ill patients with acute brain injury, as the clinical neurological examination becomes unreliable or impossible when patients are sedated, paralyzed, or deeply comatose 1, 2
The Neurocritical Care Society suggests that all patients with acute brain injury and unexplained persistent altered consciousness require neuromonitoring 3
The European Society of Intensive Care Medicine recommends neuromonitoring for comatose patients after cardiac arrest, during and after therapeutic hypothermia 3
The American Heart Association recommends neuromonitoring for patients with traumatic brain injury, subarachnoid hemorrhage, intracerebral hemorrhage, or ischemic stroke 1, 4
The American Academy of Neurology recommends EEG for patients with status epilepticus or refractory seizures, as non-convulsive seizures occur in approximately 50% of at-risk patients and cannot be detected clinically 3

The Society of Critical Care Medicine recommends electrocardiography, pulse oximetry, and blood pressure monitoring as fundamental for all neurocritical care patients, despite limited Level I evidence 2, 4
The Neurocritical Care Society suggests that invasive arterial blood pressure monitoring is recommended for all unstable patients or those at risk in the ICU 4
The American College of Critical Care Medicine recommends using the Glasgow Coma Scale (GCS) combined with pupillary examination or the FOUR scale for comatose patients with acute brain injury 4

The European Society of Intensive Care Medicine recommends brain oxygenation monitoring in patients with risk of cerebral ischemia or hypoxia using brain tissue oxygen tension (PbtO2) and jugular venous oxygen saturation (SjvO2) 4
The American Academy of Neurology recommends cerebral microdialysis for monitoring patients with or at risk of cerebral ischemia, hypoxia, energy failure, and glucose deprivation 3

The Society of Critical Care Medicine recommends the combined use of multiple monitors ("multimodality monitoring") as the standard approach, as no single monitor changes outcomes—rather, it is the integration of information into clinical decision-making and subsequent treatment that influences mortality and morbidity 2, 5
The Neurocritical Care Society suggests that review trends rather than isolated values to avoid misinterpretation, ensure all monitoring data is readily accessible and displayed, and systematically review all monitoring modalities during multidisciplinary rounds 6