Pediatric Multimodal Neuromonitoring
The first injury takes seconds.
The second injury takes hours.
A free, evidence-anchored source in pediatric multimodal neuromonitoring, for PICU fellows, intensivists, and trainees.
Five signal streams, pressure, flow, oxygen, metabolism, and electrical activity, read on the same patient and interpreted together, to catch the secondary-injury cascade the bedside exam misses.
What it is
Five signals. One brain. Real time.
Modern pediatric neurocritical care no longer treats the brain as a single number. Five physiological domains are monitored in parallel, each catches a different mode of secondary injury that the others would miss. No single signal is enough; the clinical question only resolves when the streams are interpreted together. Hover a vertex below to isolate its spoke.
Pressure
ICP · CPP · PRx · CPPopt
Flow
TCD · Mx · Direct CBF
Oxygen
NIRS · PbtO₂ · SjvO₂
Metabolism
Microdialysis
Electrical
EEG · qEEG · aEEG · BIS · NPi · EPs
Plus pupillometry, ONSD ultrasound, fontanelle US, brain temperature, and non-invasive ICP estimators, bedside anchors that cross every domain.
See all 27 modalitiesWhy it matters
Secondary injury is the part we can change.
Primary injury is over before the patient reaches the PICU. The second wave unfolds over the following hours to days: ischemia, edema, seizures, excitotoxicity, spreading depolarization. This is the window monitoring opens.
- · Trauma / contusion
- · Hemorrhage
- · Anoxia / cardiac arrest
- · Ischemic stroke
- · Status epilepticus
- · HIE
- · Time-to-detection
- · Time-to-treatment
- · Individualised targets (CPPopt)
- · Seizure burden reduction
- · Avoiding secondary hits
KidsBrainIT 2025 shows a dose-response between cumulative ICP > 20 mmHg burden, sub-target CPP, and 6-month GOS, the field's clearest evidence that what we monitor and how we respond changes outcomes.
Start here
How this site works
Four ways in. New to neuromonitoring? Start with the foundations. Here for one monitor or one case? Go straight there, or search the whole site.
Search modalities, foundations, and casesSearchA 9-chapter curriculum: autoregulation, Monro-Kellie, the pediatric brain. Begin at chapter 1.
Open27 pages, one per monitor, each paired with an interactive widget.
Open18 worked clinical cases where two or three monitors agree, or disagree.
OpenTry it live
Try the interactive widgets to improve your understanding.
This is the CPPopt optimiser. Drag through four hours of data and watch the autoregulation U-curve form; its vertex is the patient's individualised CPP target.
When monitors disagree
18 worked clinical cases.
These are examples that the monitors are read together, not in isolation. Each case walks a scenario where two or three modalities tell different stories, and shows how to resolve it at the bedside.
PRx vs COx discordance in TBI
TBI patient: PRx says intact, COx says impaired. Why?
PRxCOxNIRSA 4-hour CPPopt loop, COGiTATE-style
Walk through the 4-hour CPPopt computation and how to act on the orange band.
CPPoptPRxCPPDKA cerebral oedema, Asher, 9y
New DKA, severe acidosis. Hour 4 of fluids: GCS drops, irritable, headache. What is your monitoring plan?
Clinical examNPiONSDNIRS