Multimodal Monitoring

Multimodal monitoring in neurocritical care involves constant patient bedside measurements of brain physiology using various tools to detect clinically important events in real time for patients with acute brain injury or those at risk. By integrating synchronized data, this approach provides a deeper understanding of brain function compared to isolated data points. It is increasingly valued in clinical decision-making, enhancing traditional neurological examinations.

Existing Challenges in Pediatric Neurocritical Care

Secondary brain injury can develop in the hours and days following an initial brain injury, influenced by factors such as brain swelling (cerebral edema), lack of oxygen (brain tissue hypoxia) and/or abnormal cerebral blood flow. While guidelines help standardize care for most patients, personalized care is often essential, particularly for children, due to differences in age, genetics and other factors.

Monitoring Tools

In the neurocritical care environment, multiple tools are used to monitor for secondary brain injury, including:

  • Brain tissue oxygenation monitoring with near infrared spectroscopy
  • Continuous electroencephalography (EEG)
  • Intracranial pressure (ICP) monitoring
  • Pupillometry
  • Transcranial Doppler ultrasound (TCD)

Each tool offers a limited view of real-time brain physiology and integrating the tools together provides a more comprehensive understanding of brain function. These advanced calculations of cerebrovascular pressure reactivity, brain compliance and autonomic function help optimize patient care.

Real-Time Analysis at Phoenix Children’s

The Neurocritical Care Program at the Barrow Neurological Institute at Phoenix Children’s uses multimodality neurological monitoring units in the pediatric, cardiac and neonatal intensive care units. These units synchronize data from various brain and systemic monitoring tools, streaming it in real time across the health system, allowing clinicians to monitor brain physiology from multiple locations.

Advanced software analyzes this data to provide a better understanding of brain function and dynamics, providing insights into a patient’s clinical state and determining optimal blood pressure or ventilatory targets.

Research, Education and Future Directions

The collection and storage of high-resolution physiologic data offers unique opportunities for scientific investigation into biomarkers of brain injury and recovery. Over the past several years, Phoenix Children’s has secured funding from the United States Department of Defense, the American Heart Association and the Pediatric Epilepsy Research Foundation. Our research has led to predictive models for early posttraumatic seizures, intracranial hypertension and physiologic biomarkers for post-traumatic epilepsy and functional outcomes.

As leaders in multimodal monitoring, we participate in large multicenter consortiums and provide educational lectures on the latest evidence and clinical practices. Through our Pediatric Neurocritical Care Fellowship, we train the next generation of physicians in advanced neuromonitoring practices. We aim to expand collaborations nationally and internationally to conduct larger prospective studies, continually seeking innovative ways to improve care for children with critical illnesses.