A Survey of Neuromonitoring Practices in North American Pediatric Intensive Care Units.
Publication/Presentation Date
1-1-2022
Abstract
BACKGROUND: Neuromonitoring is the use of continuous measures of brain physiology to detect clinically important events in real-time. Neuromonitoring devices can be invasive or non-invasive and are typically used on patients with acute brain injury or at high risk for brain injury. The goal of this study was to characterize neuromonitoring infrastructure and practices in North American pediatric intensive care units (PICUs).
METHODS: An electronic, web-based survey was distributed to 70 North American institutions participating in the Pediatric Neurocritical Care Research Group. Questions related to the clinical use of neuromonitoring devices, integrative multimodality neuromonitoring capabilities, and neuromonitoring infrastructure were included. Survey results were presented using descriptive statistics.
RESULTS: The survey was completed by faculty at 74% (52 of 70) of institutions. All 52 institutions measure intracranial pressure and have electroencephalography capability, whereas 87% (45 of 52) use near-infrared spectroscopy and 40% (21/52) use transcranial Doppler. Individual patient monitoring decisions were driven by institutional protocols and collaboration between critical care, neurology, and neurosurgery attendings. Reported device utilization varied by brain injury etiology. Only 15% (eight of 52) of institutions utilized a multimodality neuromonitoring platform to integrate and synchronize data from multiple devices. A database of neuromonitoring patients was maintained at 35% (18 of 52) of institutions. Funding for neuromonitoring programs was variable with contributions from hospitals (19%, 10 of 52), private donations (12%, six of 52), and research funds (12%, six of 52), although 73% (40 of 52) have no dedicated funds.
CONCLUSIONS: Neuromonitoring indications, devices, and infrastructure vary by institution in North American pediatric critical care units. Noninvasive modalities were utilized more liberally, although not uniformly, than invasive monitoring. Further studies are needed to standardize the acquisition, interpretation, and reporting of clinical neuromonitoring data, and to determine whether neuromonitoring systems impact neurological outcomes.
Volume
126
First Page
125
Last Page
130
ISSN
1873-5150
Published In/Presented At
Kirschen, M. P., LaRovere, K., Balakrishnan, B., Erklauer, J., Francoeur, C., Ganesan, S. L., Jayakar, A., Lovett, M., Luchette, M., Press, C. A., Wolf, M., Ferrazzano, P., Wainwright, M. S., Appavu, B., & Pediatric Neurocritical Care Research Group (PNCRG) (2022). A Survey of Neuromonitoring Practices in North American Pediatric Intensive Care Units. Pediatric neurology, 126, 125–130. https://doi.org/10.1016/j.pediatrneurol.2021.11.002
Disciplines
Medicine and Health Sciences | Pediatrics
PubMedID
34864306
Department(s)
Department of Pediatrics
Document Type
Article