The Brussels consensus for non-invasive ICP monitoring when invasive systems are not available in the care of TBI patients (the B-ICONIC consensus, recommendations, and management algorithm)

Robba C 1 , Picetti E 2 , Vásquez-García S 3 , Abulhasan YB 4 , Ain A 5 , Adeleye AO 6 Show all authors , Aries M 7 , Brasil S 8 , Badenes R 9 , Bertuccio A 10 , Bouzat P 11 , Bustamante L 12 , Calabro' L 13 , Njimi H 13 , Cardim D 14 , Citerio G 15 , Czosnyka M 16 , Geeraerts T 17 , Godoy DA 18 , Hirzallah MI 19 , Devi BI 20 , Jibaja M 21 , Lochner P 22 , Mijangos Méndez JC 23 , Meyfroidt G 24 , Munusamy T 25 , Portilla JP 26 , Prabhakar H 27 , Rasulo F 28 , Sánchez Parra DM 29 , Sarwal A 30 , Shrestha GS 31 , Shukla DP 32 , Sung G 33 , Tirsit A 34 , Vásquez F 35 , Videtta W 36 , Wang YL 37 , Paiva WS 38 , Taccone FS 13 , Rubiano AM 39

Affiliations 

  • 1 IRCCS Ospedale Policlinico San Martino, Genoa, Italy. kiarobba@gmail.com
  • 2 Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
  • 3 Neurosciences and Intensive Care Department, Clínica del Country, Bogotá, Colombia
  • 4 Faculty of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
  • 5 Department of Anesthesiology and Intensive Care, Hospital Sultan Abdul Halim, Kedah, Malaysia
  • 6 Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
  • 7 Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
  • 8 Department of Neurology, University of São Paulo, São Paulo, Brazil
  • 9 Department of Surgery, University of Valencia, Valencia, Spain
  • 10 Department of Neurosurgery, St. Antonio and Biagio and Cesare Arrigo Hospital, Neurosurgery Unit, Alessandria, Italy
  • 11 Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Institut des Neurosciences, Pôle Anesthésie Réanimation, Grenoble Alpes University, Grenoble, France
  • 12 Universidad Pontificia Javeriana, Cali, Colombia
  • 13 Department of Intensive Care, Hospital Erasme, Universitè Libre De Bruxelles, Brussels, Belgium
  • 14 Department of Neurology, University of Texas Southwestern Medical Center, Dallas, USA
  • 15 School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
  • 16 Division of Neurosurgery, Department of Clinical Neurosciences, Brain Physics Laboratory, University of Cambridge, Cambridge, UK
  • 17 Pôle Anesthésie-Réanimation, Inserm, UMR 1214, Toulouse Neuroimaging Center, ToNIC, Université Toulouse 3-Paul Sabatier, CHU de Toulouse, 31059, Toulouse, France
  • 18 Departamento Medicina Critica, Unidad de Cuidados Neurointensivos, Sanatorio Pasteur, Catamarca, Argentina
  • 19 Department of Neurology, Baylor College of Medicine, Houston, TX, USA
  • 20 Department of Neurosurgery, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
  • 21 Hospital Eugenio Espejo and Escuela de Medicina de la Universidad San Francisco de Quito, Quito, Ecuador
  • 22 Department of Neurology, Saarland University Medical Center, Homburg, Germany
  • 23 Unidad de Terapia Intensiva, Hospital Civil Fray Antonio Alcalde, Universidad de Guadalajara, Coronel Calderón 777, El Retiro, Guadalajara, Jalisco, Mexico
  • 24 Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU, Louvain, Belgium
  • 25 Department of Neurosurgery, Singapore General Hospital, Singapore, Singapore
  • 26 Unidad de Cuidados Intensivos, Clinicas AUNA, Chiclayo, Peru
  • 27 Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
  • 28 Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
  • 29 University of Medical Sciences of Havana, Havana, Cuba
  • 30 Department of Neurology, Cooper Medical School of Rowan University, Camden, NJ, USA
  • 31 Department of Anesthesiology, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
  • 32 Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
  • 33 University of Southern California, Los Angeles, USA
  • 34 Neurosurgery Division, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
  • 35 Hospital Dr. Darío Contreras, Santo Domingo, República Dominicana
  • 36 Hospital Nacional Professor Alejandro Posadas, Buenos Aires, Argentina
  • 37 Neuro Intensive Care Unit, Tan Tock Seng Hospital, Singapore, Singapore
  • 38 Department of Neurosurgery, University of São Paulo, São Paulo, Brazil
  • 39 Global Health Research Group in Acquired Brain and Spine Injuries, Cambridge, UK
Intensive Care Med, 2025 Jan;51(1):4-20.
PMID: 39847066 DOI: 10.1007/s00134-024-07756-2

Abstract

BACKGROUND: Invasive systems are commonly used for monitoring intracranial pressure (ICP) in traumatic brain injury (TBI) and are considered the gold standard. The availability of invasive ICP monitoring is heterogeneous, and in low- and middle-income settings, these systems are not routinely employed due to high cost or limited accessibility. The aim of this consensus was to develop recommendations to guide monitoring and ICP-driven therapies in TBI using non-invasive ICP (nICP) systems.

METHODS: A panel of 41 experts, that regularly use nICP systems for guiding TBI care, was established. Three scoping and four systematic reviews with meta-analysis were performed summarizing the current global-literature evidence. A modified Delphi method was applied for the development of recommendations. An in-person meeting with group discussions and voting was conducted. Strong recommendations were defined for an agreement of at least 85%. Weak recommendations were defined for an agreement of 75-85%.

RESULTS: A total of 34 recommendations were provided (32 Strong, 2 Weak) divided into three domains: general consideration for nICP use, management of ICP using nICP methods and thresholds of nICP tools for escalating/de-escalating treatment. We developed four clinical algorithms for escalating treatment and heatmaps for de-escalating treatment.

CONCLUSIONS: Using a mixed-method approach involving literature review and an in-person consensus by experts, a set of recommendations designed to assist clinicians managing TBI patients using nICP systems plus clinical assessment, in the presence or absence of brain imaging, were built. Further clinical studies are required to validate the potential use of these recommendations in the daily clinical practice.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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