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  • Review Article
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Multimodal monitoring and neurocritical care bioinformatics

Nature Reviews Neurology volume 7, pages 451–460 (2011)Cite this article

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Abstract

Neurocritical care bioinformatics is a new field that focuses on the acquisition, storage and analysis of physiological and other data relevant to the bedside care of patients with acute neurological conditions such as traumatic brain injury or stroke. The main focus of neurocritical care for these conditions relates to prevention, detection and management of secondary brain injury, which relies heavily on monitoring of systemic and cerebral parameters (such as blood-pressure level and intracranial pressure). Advanced neuromonitoring tools also exist that enable measurement of brain tissue oxygen tension, cerebral oxygen utilization, and aerobic metabolism. The ability to analyze these advanced data for real-time clinical care, however, remains intuitive and primitive. Advanced statistical and mathematical tools are now being applied to the large volume of clinical physiological data routinely monitored in neurocritical care with the goal of identifying better markers of brain injury and providing clinicians with improved ability to target specific goals in the management of these patients. This Review provides an introduction to the concepts of multimodal monitoring for secondary brain injury in neurocritical care and outlines initial and future approaches using informatics tools for understanding and applying these data to clinical care.

Key Points

  • Monitoring for secondary brain injury is a fundamental aspect of neurocritical care

  • Advances in neuromonitoring technologies have been profound and now include the ability to directly monitor brain oxygenation, cerebral blood flow, and cerebral metabolism in, essentially, real time

  • Despite these advances, data from bedside monitors in neurocritical care are evaluated by clinicians in much the same way as 40 years ago

  • Informatics has fundamentally changed many fields in medicine including epidemiology, genetics and pharmacology

  • New data-acquisition, storage and analytical tools are now being applied to neurocritical care data to harness the large volume of data now available to clinicians

  • Neurocritical care bioinformatics is an emerging field that will require collaboration between clinicians, computer scientists, engineers, and informatics experts to bring user-friendly, real-time advances to the patient bedside

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Figure 1: The neurocritical care environment.
Figure 2: Kiosk-type critical care data acquisition system.
Figure 3: Decision tree analysis for prediction of outcome after traumatic brain injury.
Figure 4: Self-organizing heat map of physiological variables for neurocritical care.

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Acknowledgements

J. C. Hemphill is funded in part by grant U10 NS058931 from the US NIH. P. Andrews has received funding from the European Society of Intensive Care Medicine for the Eurotherm3235 Trial.

L. Barclay, freelance writer and reviewer, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape, LLC-accredited continuing medical education activity associated with this article.

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  1. Department of Neurology, Brain and Spinal Injury Center, San Francisco General Hospital, Room 4M62, 1001 Potrero Avenue, San Francisco, 94110, CA, USA

    J. Claude Hemphill

  2. Department of Critical Care, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK

    Peter Andrews

  3. Center for Neurocritical Care, Neurological Institute, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, 44106–5040, OH, USA

    Michael De Georgia

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J. C. Hemphill has acted as a consultant for, and holds shares of stock for, Ornim. M. De Georgia has acted as a consultant for Orsan Medical Technologies. P. Andrews declares no competing interests.

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Hemphill, J., Andrews, P. & De Georgia, M. Multimodal monitoring and neurocritical care bioinformatics. Nat Rev Neurol 7, 451–460 (2011). https://doi.org/10.1038/nrneurol.2011.101

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