Neuromonitoring in neurocritical care for traumatic brain injury in the Thai context

Neuromonitoring for traumatic brain injury in Thailand

Authors

  • Panu Boontoterm Neurological surgery unit, Department of surgery, Phramongkutklao Hospital, Bangkok, Thailand, 10400 https://orcid.org/0000-0002-3989-1301
  • Siraruj Sakoolnamarka Neurological surgery unit, Department of surgery, Phramongkutklao Hospital, Bangkok, Thailand, 10400
  • Peera Nakla-or Neurological surgery unit, Department of surgery, Phramongkutklao Hospital, Bangkok, Thailand, 10400
  • Prateep Phontien Neurological surgery unit, Department of surgery, Phramongkutklao Hospital, Bangkok, Thailand, 10400
  • Pusit Fuengfoo Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand, 10400

DOI:

https://doi.org/10.54205/ccc.v32.267083

Keywords:

Traumatic brain injury, Neuro-monitoring, Cerebral Autoregulation, Cerebral homeostasis, Secondary brain injury

Abstract

The purposes of this review were to identify the incidence and types of traumatic brain injury (TBI) in Thailand, and recommend neuro-monitoring for limited resources in Thai patients. The monitoring methods focus on the targeted and personalized management in severe TBI such as intracranial pressure (ICP), pressure reactivity index (PRx), regional cerebral saturation (rSO2), cerebral autoregulation (CA), as well as noninvasive methods for example near-infrared spectroscopy (NIRS) and optic nerve sheath diameter (ONSD). These monitors are aimed to optimize brain oxygen delivery and prevent further neurologic deterioration in terms of increased ICP and decreased cerebral perfusion pressure (CPP). Some of these were implemented in neurological monitoring protocol and clinical practice guidelines for severe TBI. However, cost - effectiveness is concerned. Even though considering CA and the advance monitoring methods in continuous assessment are widely used, current therapeutic interventions which appear entirely to bedside approach for correct dysregulated CA are limited. In addition, understanding of basic molecular and cellular pathways involved in cerebral homeostasis ( brain oxygen delivery, cerebral blood flow, CA and cerebral vascular reactivity to oxygen and carbon dioxide) as well as secondary brain injury prevention are still necessary for improving TBI outcomes. In summary, further study in Thailand is required to determine optimal cerebral physiologic-based technology, monitoring parameters, and individualized thresholds to optimize CA and potentially improve neurologic outcomes across a spectrum of TBI patients, which focus in Thai rural areas where invasive monitoring is not routinely performed due to resources limitation. Encourage and training of non invasive methods might solve these issues.

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Published

2024-04-02

How to Cite

1.
Boontoterm P, Sakoolnamarka S, Nakla-or P, Phontien P, Fuengfoo P. Neuromonitoring in neurocritical care for traumatic brain injury in the Thai context: Neuromonitoring for traumatic brain injury in Thailand. Clin Crit Care [Internet]. 2024 Apr. 2 [cited 2024 Jun. 21];32(1):e240007. Available from: https://he02.tci-thaijo.org/index.php/ccc/article/view/267083

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Section

Review Articles