A 48-year-old man is admitted to the intensive care unit following a severe traumatic brain injury sustained in a motor vehicle accident. He is intubated on assist-control ventilation, receiving a continuous propofol infusion for sedation, and norepinephrine to maintain mean arterial pressure. A central venous catheter is in place. Despite initial management, his intracranial pressure (ICP) has remained at 28 mmHg for the past 2 hours, with a cerebral perfusion pressure of 55 mmHg. CT imaging reveals diffuse cerebral edema and effacement of the basal cisterns. An external ventricular drain (EVD) is placed for cerebrospinal fluid (CSF) drainage. Which statement best describes the primary mechanism responsible for the expected reduction in ICP after this intervention?

A 3-day-old neonate is in the neonatal intensive care unit (NICU) following a perinatal hypoxic-ischemic event. The infant is undergoing therapeutic hypothermia, requires mechanical ventilation, and has a central venous catheter in place. The clinical team is evaluating the optimal neuromonitoring strategy to guide management and predict long-term outcomes. Which of the following integrated neuromonitoring strategies is most appropriate for assessing cerebral function, detecting electrographic seizures, and predicting neurodevelopmental outcomes in this neonate?

A 2-day-old neonate is in the pediatric critical care unit following hypoxic-ischemic encephalopathy (HIE) at birth. The infant is receiving therapeutic hypothermia, is mechanically ventilated, and has a central venous catheter in place. Continuous monitoring is initiated due to a high suspicion for subclinical seizure activity. Which neuromonitoring modality is most appropriate for the real-time detection of electrographic seizures and detailed assessment of cerebral function in this patient?

A term neonate, 24 hours old, is in the neonatal critical care unit following a perinatal hypoxic-ischemic event. The infant is undergoing therapeutic hypothermia, has a central venous line in place, and is receiving mechanical ventilation. The clinical team is considering continuous EEG (cEEG) and near-infrared spectroscopy (NIRS) for neuroprognostication. Which of the following represents a primary barrier to the routine implementation of continuous neuromonitoring techniques in neonates with hypoxic-ischemic encephalopathy in the NICU?

A 62-year-old man is admitted to the intensive care unit following a severe stroke. He is managed with assist-control ventilation and a continuous propofol infusion for sedation. A central venous catheter is in place for infusions and monitoring. During evening rounds, the clinical team discusses the patient’s fluctuating levels of consciousness and considers the utility of initiating continuous electroencephalography (EEG) or bispectral index (BIS) monitoring to assess sleep-wake cycles. The patient’s current Richmond Agitation-Sedation Scale (RASS) score is –3, and his vital signs are stable. Based on current evidence for neuromonitoring in critically ill adults, which statement is the MOST appropriate interpretation regarding the routine use of continuous EEG or BIS for assessing sleep in this patient?

A 48-year-old man is in the neurocritical care unit 48 hours after a severe traumatic brain injury. His Glasgow Coma Scale score is 3T. He is intubated, on assist-control ventilation, and has an external ventricular drain in place. His intracranial pressure has been stable at 12–15 mm Hg, and his mean arterial pressure is maintained at 80 mm Hg with a continuous norepinephrine infusion. He has been receiving a continuous propofol infusion at 50 mcg/kg/min for sedation for the past 12 hours. During nursing rounds, continuous electroencephalography (cEEG) monitoring reveals a new pattern characterized by low-voltage activity with persistent burst suppression. Which of the following is the most likely cause of this new EEG pattern?

A 45-year-old man is admitted to the neurocritical care unit after a severe traumatic brain injury. He is on assist-control ventilation with a propofol infusion at 50 mcg/kg/min via a central line. During evening rounds, the care team reviews his intracranial pressure (ICP) readings from his external ventricular drain (EVD). Over the past 4 hours, his ICP has consistently ranged between 23–26 mm Hg, with occasional spikes to 30 mm Hg, despite initial efforts to optimize head positioning and ensure adequate sedation. His mean arterial pressure (MAP) is maintained at 85 mm Hg. His Glasgow Coma Scale (GCS) score is unassessable due to deep sedation and intubation. Which statement best describes the clinical significance of these findings?

A 2-day-old term neonate with moderate hypoxic-ischemic encephalopathy (HIE) is undergoing therapeutic hypothermia (33.5 °C) in the NICU. He is hemodynamically stable on no inotropic support and is receiving a morphine infusion at 10 μg/kg/h for sedation. A central venous catheter is in place, and he is on CPAP at 6 cm H₂O with FiO₂ 30%. Continuous EEG shows persistent burst suppression and intermittent electrographic seizures despite a 20 mg/kg loading dose of phenobarbital administered 6 hours ago. Amplitude-integrated EEG confirms a high seizure burden. Which of the following is the most appropriate next pharmacologic intervention?

A 45-year-old man is admitted to the intensive care unit following a severe traumatic brain injury. He is intubated on assist-control ventilation and receiving a continuous propofol infusion for sedation. During morning rounds, his Glasgow Coma Scale (GCS) score is documented as 3T, and pupillary responses are noted to be sluggish but reactive. Considering the patient’s current clinical status, which of the following neuromonitoring assessments presents the MOST significant challenge to accurate interpretation due to his intubation and continuous sedation?

A 45-year-old man is in the neurocritical care unit following a severe traumatic brain injury (TBI). He is mechanically ventilated on an assist-control setting with a propofol infusion administered via a central line. His intracranial pressure (ICP) is stable at 12 mmHg, and cerebral perfusion pressure (CPP) is maintained at 68 mmHg. Due to a persistently low Glasgow Coma Scale (GCS) score of 3T and subtle, fluctuating motor activity, continuous electroencephalography (cEEG) was initiated. The cEEG reveals frequent, generalized non-convulsive seizure activity. Which of the following pharmacotherapy interventions is most appropriate based on these findings?