The Safety of Multimodal Monitoring using a triple lumen bolt in Severe Acute Brain Injury.

Abstract

BACKGROUND\nMultimodal monitoring (MMM) is used frequently to guide care of patients with severe acute brain injury. In this study we examined the safety and reliability of multimodality monitoring.\n\n\nMETHODS\nFive hundred and one patients, including 300 males and 201 females (mean age 58 + 39 years) were identified retrospectively from a prospective observational database at a Level I Trauma Center. Each patient received a triple lumen bolt and 3 monitors: intracranial pressure, brain temperature and brain oxygen (Licox, Integra NeuroSciences). ICU and hospital records were examined to identify complications, reasons for device replacement, malfunction and infection. Head CT scans obtained both before and after the monitors were inserted, were examined for evidence of monitor-related adverse effects.\n\n\nRESULTS\nA total of 696 triple lumen bolts were placed. The median (IQR) duration of monitoring was 78.88 hours (33.0-133.2). Twenty-two (3.16%) patients had bilateral monitors. Ten (1.43%) monitors were replaced to allow MR imaging and 40 (5.74%) were replaced to facilitate additional cranial surgery. Thirty-five (5.02%) monitors were replaced because they were thought to not be functioning properly; among these, 19 (54.29%) were subsequently found to be functioning normally. Follow up CT scans were compared with pre-insertion CT scans: 9 (2.13%) small contusions and 10 (2.36%) extra-axial hematomas associated with the devices were identified. Based on the CT findings, the hematomas were thought to be associated with the insertion technique rather than the device. Four hematomas required treatment. Twenty-two (3.16%) devices were incorrectly placed, e.g. the probe was in an infarct or an already existing contusion. Only 1 associated infection was identified.\n\n\nCONCLUSION\nPlacement of intracranial monitors for multimodality neuromonitoring using a triple lumen bolt appears to be safe. The complication rate is similar to that published for single-lumen bolts and single monitors.