Does multimodality monitoring make a difference in neurocritical care?

Despite the many tools available for monitoring the central nervous system, there are no clinical trials which prove that continuous monitoring of any single variable in the intensive care unit has had any significant impact on the outcome of patients. The main reasons for monitoring neurocritical patients could be summarized as follows: 1) to detect early neurological worsening before irreversible brain damage occurs, 2) to individualize patient care decisions, 3) to guide patient management, 4) to monitor therapeutic response of some interventions and to avoid any consequent adverse effects, 5) to allow clinicians to be able to understand the pathophysiology of complex disorders, 6) to design and implement management protocols and, 7) to improve neurological outcome and quality of life in survivors of severe brain injuries. To reach these goals, there is a need to overcome some obstacles, such as the learning curve needed for any monitor and establishing consensus among experts on how to interpret monitor readings. In this lecture, the obstacles confronted in running randomized clinical trials in this field are discussed. In addition, the reasons for failure to improve outcome through the use of some monitoring devices are discussed and potential solutions proposed.