NONINVASIVE NEUROMONITORING IN TRAUMATIC BRAIN INJURY: FROM EMERGING ALTERNATIVE TO REAL PERSPECTIVE

• DOI: https://doi.org/10.22533/at.ed.15953126020112

• Palavras-chave: traumatic brain injury, neurological monitoring, intracranial pressure.

• Keywords: traumatic brain injury, neurological monitoring, intracranial pressure.

• Abstract:

  Traumatic brain injury (TBI) is a major cause of mortality and neurological disability, whose clinical course is largely determined by the development of secondary brain damage. Traditionally, the management of moderate and severe TBI has been based on invasive monitoring of intracranial pressure; however, this approach has limitations in capturing the complexity and dynamics of brain physiology. In this context, noninvasive neuromonitoring has emerged as a complementary strategy aimed at the continuous assessment of different functional domains of the injured brain.
  This narrative review analyzes the current evidence on noninvasive neuromonitoring in TBI, addressing its pathophysiological basis, main modalities, reference values, clinical utility, and limitations. Tools such as automated pupillometry, transcranial Doppler, measurement of the diameter of the optic nerve sheath, continuous electroencephalography, and near-infrared spectroscopy allow for the early detection of alterations in perfusion, oxygenation, cortical activity, and intracranial compliance. The available evidence supports their usefulness for early detection of neurological deterioration, risk stratification, and dynamic patient monitoring, especially when integrated multimodally and interpreted in trends.
  Although noninvasive neuromonitoring does not replace invasive monitoring in selected patients, its application represents a real and applicable perspective in contemporary neurocritical care, particularly in resource-limited settings and in the early stages of TBI.