Multimodal online monitoring in middle cerebral artery territory stroke

Background and Purpose-Patients with large middle cerebral artery infarctio n and elevated intracranial pressure (ICP) who are undergoing invasive inte nsive care therapy require technical monitoring. However, the effectiveness of the current gold standard, measurement of lCP, is limited. Furthermore, the effects of what is considered to be standard antiedema medical treatme nt are not fully understood. We studied whether multimodal monitoring can h elp to overcome this problem. Methods-ICP, cerebral perfusion pressure (CPP), and partial brain tissue ox ygen pressure (Pbro(2)) were continuously measured within the white matter of the frontal lobe unilaterally or bilaterally. We analyzed the effects of antiedema drugs and looked for pattern changes in the Pbro2 before transte ntorial herniation in patients in whom this could not be prevented. Further more, complications were registered. Results-We performed 27 measurements in 21 patients. A total of 297 antiede ma drug administrations were analyzed in 11 patients. Hyper-HAES and mannit ol were most often associated with an increase in CPP and Pbro(2), whereas the use of thiopental and tromethamine led to negative or contrary effects, although ICP was decreased in every case. Pattern changes in the Pbro(2) c urve could be observed between 6 to 18 hours before transtentorial herniati on. No bleeding complication or infections were observed. Conclusions-Multimodal monitoring can be used to monitor antiedema drug eff ects. Our data suggest that with multimodal monitoring, pathophysiological changes could be predicted considerably in advance. ICP alone is of questio nable use. Furthermore, this method might help to optimize the timing of in vasive therapy in space-occupying infarction.