Evidenced Based Clinical Review: Intracranial Monitoring, Brain Tissue Oxygen Monitoring, Bispectral Monitoring-AANN23

Video Transcription

Video Summary

The webinar presents an evidence-based clinical review and bedside quick guides for intracranial pressure (ICP), brain tissue oxygenation, and bispectral index (BIS) monitoring. Because the literature was insufficient to support firm clinical practice guidelines, the review summarizes available research and highlights evidence gaps. The authors searched major databases, screened studies in duplicate, and synthesized findings around clinical questions.<br /><br />For ICP monitoring, intraparenchymal monitors and external ventricular drains (EVDs) have distinct uses and risks. Infection is a major concern; bundles and careful handling may reduce risk, but evidence is limited on catheter duration, placement, site care, sampling, and drainage methods. Nurses should follow institutional protocols and manufacturer instructions, prevent over-drainage, and pair device readings with neurological assessments.<br /><br />Brain tissue oxygenation monitoring can identify cerebral hypoxia, including episodes that occur without elevated ICP. It may complement ICP monitoring, particularly in traumatic brain injury and subarachnoid hemorrhage, although optimal placement and duration remain uncertain.<br /><br />BIS provides a continuous EEG-derived estimate of consciousness and may help assess sedation, especially during neuromuscular blockade. Evidence for improved safety or outcomes is inconsistent, and its role in predicting neurological recovery or brain death requires further study. Across all three modalities, the presentation emphasizes cautious interpretation, vigilant assessment, and the need for stronger research.

Keywords

intracranial pressure

ICP monitoring

brain tissue oxygenation

bispectral index

BIS monitoring

external ventricular drain

neurocritical care

traumatic brain injury

subarachnoid hemorrhage