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Neuromonitoring of Pediatric and Adult Extracorporeal Membrane Oxygenation Patients: The Importance of Continuous Bedside Tools in Driving Neuroprotective Clinical Care

体外膜肺氧合 医学 重症监护医学 镇静 神经保护 麻醉 内科学
作者
Margherita Tabet,Chasity M. Custer,Imad Khan,Ethan L. Sanford,Jayesh Sharma,Regine Choe,Sumit Randhir Singh,Deepa Sirsi,DaiWai M. Olson,Michael C. Morriss,Lakshmi Raman,David R. Busch
出处
期刊:Asaio Journal [Lippincott Williams & Wilkins]
卷期号:70 (3): 167-176 被引量:1
标识
DOI:10.1097/mat.0000000000002107
摘要

Extracorporeal membrane oxygenation (ECMO) is a form of temporary cardiopulmonary bypass for patients with acute respiratory or cardiac failure refractory to conventional therapy. Its usage has become increasingly widespread and while reported survival after ECMO has increased in the past 25 years, the incidence of neurological injury has not declined, leading to the pressing question of how to improve time-to-detection and diagnosis of neurological injury. The neurological status of patients on ECMO is clinically difficult to evaluate due to multiple factors including illness, sedation, and pharmacological paralysis. Thus, increasing attention has been focused on developing tools and techniques to measure and monitor the brain of ECMO patients to identify dynamic risk factors and monitor patients’ neurophysiological state as a function in time. Such tools may guide neuroprotective interventions and thus prevent or mitigate brain injury. Current means to continuously monitor and prevent neurological injury in ECMO patients are rather limited; most techniques provide indirect or postinsult recognition of irreversible brain injury. This review will explore the indications, advantages, and disadvantages of standard-of-care, emerging, and investigational technologies for neurological monitoring on ECMO, focusing on bedside techniques that provide continuous assessment of neurological health.
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