Neuromonitoring: an update {AU query: is this a Clinical review or Bench-to-bedside review?}

Critically ill patients are frequently at risk of neurological dysfunction as a result of primary neurological conditions or secondary insults. Determining which aspects of brain function are aff ected and how best to manage the neurological dysfunction can often be diffi cult and is complicated by the limited information that can be gained from clinical examination in such patients and the eff ects of therapies, notably sedation, on neurological function. Methods to measure and monitor brain function have evolved considerably in recent years and now play an important role in the evaluation and management of patients with brain injury. Importantly, no single technique is ideal for all patients and diff erent variables will need to be monitored in diff erent patients; in many patients, a combination of monitoring techniques will be needed. Although clinical studies support the physiologic feasibility and biologic plausibility of management based on information from various monitors, data supporting this concept from randomized trials are still required.