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Battaglini D, Premraj L, Huth S, Fanning J, Whitman G, Arora RC, Bellapart J, Porto DB, Taccone FS, Suen JY, Bassi GL, Fraser JF, Cho SM, Robba C. The Use of Noninvasive Multimodal Neuromonitoring in Adult Critically Ill Patients With COVID-19 Infection. J Neurosurg Anesthesiol 2023; 35:423-428. [PMID: 35695738 PMCID: PMC9729386 DOI: 10.1097/ana.0000000000000859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Noninvasive neuromonitoring could be a valuable option for bedside assessment of cerebral dysfunction in patients with coronavirus disease-2019 (COVID-19) admitted to intensive care units (ICUs). This systematic review aims to investigate the use of noninvasive multimodal neuromonitoring in critically ill adult patients with COVID-19 infection. METHODS MEDLINE/PubMed, Scopus, Cochrane, and EMBASE databases were searched for studies investigating noninvasive neuromonitoring in patients with COVID-19 admitted to ICUs. The monitoring included transcranial Doppler ultrasonography (TCD), the Brain4care Corp. cerebral compliance monitor (B4C), optic nerve sheath diameter (ONSD), near infrared spectroscopy, automated pupillometry, and electroencephalography (EEG). RESULTS Thirty-two studies that investigated noninvasive neuromonitoring techniques in patients with COVID-19 in the ICU were identified from a systematic search of 7001 articles: 1 study investigating TCD, ONSD and pupillometry; 2 studies investigating the B4C device and TCD; 3 studies investigating near infrared spectroscopy and TCD; 4 studies investigating TCD; 1 case series investigating pupillometry, and 21 studies investigating EEG. One hundred and nineteen patients underwent TCD monitoring, 47 pupillometry, 49 ONSD assessment, 50 compliance monitoring with the B4C device, and 900 EEG monitoring. Alterations in cerebral hemodynamics, brain compliance, brain oxygenation, pupillary response, and brain electrophysiological activity were common in patients with COVID-19 admitted to the ICU; these abnormalities were not clearly associated with worse outcome or the development of new neurological complications. CONCLUSIONS The use of noninvasive multimodal neuromonitoring in critically ill COVID-19 patients could be considered to facilitate the detection of neurological derangements. Determining whether such findings allow earlier detection of neurological complications or guide appropriate therapy requires additional studies.
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Affiliation(s)
- Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for oncology and neuroscience, Genoa, Italy
- Department of Medicine, University of Barcelona, Spain
| | | | - Samuel Huth
- Critical Care Research Group (CCRG), Australia
- Faculty of Medicine, The University of Queensland, Australia
| | - Jonathon Fanning
- Critical Care Research Group (CCRG), Australia
- Faculty of Medicine, The University of Queensland, Australia
- St. Andrew’s War Memorial Hospital, Uniting Care Health, Australia
| | - Glenn Whitman
- Department of Surgery, Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, United States
| | - Rakesh C. Arora
- Department of Surgery, Section of Cardiac Surgery, Max Rady College of Medicine, University of Manitoba, Canada
| | - Judith Bellapart
- Critical Care Research Group (CCRG), Australia
- Royal Brisbane and Women’s Hospital, Australia
| | - Diego Bastos Porto
- Department of Critical Care, Sao Camilo Cura D’ars Hospital, Fortaleza, Cearà, Brazil
| | | | - Jacky Y. Suen
- Critical Care Research Group (CCRG), Australia
- Faculty of Medicine, The University of Queensland, Australia
| | - Gianluigi Li Bassi
- Critical Care Research Group (CCRG), Australia
- Faculty of Medicine, The University of Queensland, Australia
- Queensland University of Technology, Australia
- Institut de Ricerca Biomedica August Pi i Sunyer (IDIBAPS), Spain
| | - John F. Fraser
- Critical Care Research Group (CCRG), Australia
- Faculty of Medicine, The University of Queensland, Australia
- St. Andrew’s War Memorial Hospital, Uniting Care Health, Australia
- Queensland University of Technology, Australia
| | - Sung-Min Cho
- Department of Surgery, Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, United States
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for oncology and neuroscience, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
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