Cerebral metabolic monitoring

Cerebral metabolic monitoring (CMM) has a long history and has developed as the technology has permitted. Indeed, technology may have been the driving force for some of the recent scientific publications. In general terms, CMM can be divided into global and focal, and within these broad categories bedside or remote monitors can be used.

Before describing a catalogue of the available monitors we must ask what it is that we wish to detect. No monitor will improve outcome itself, and this is made more likely if we monitor intermediate physiological variables with little

Figure 2.2 (a,b) Spiegelberg compliance monitoring device. Future measurement of ICP may include a continuous estimate of intracranial compliance. Tissue perfusion is more likely to be related to compliance than pressure, and critical volumetric compensatory exhaustion will be detected earlier with this measure. The Spiegelberg device is such a monitor and is currently available relationship to consumer orientated end-points (quality of survival). There has been a tendency to "make the measurable important, rather than making the important measurable".

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