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23-01-2025 | Intracranial Hypertension | Conference Reports and Expert Panel

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)

Authors: Chiara Robba, Edoardo Picetti, Sebastián Vásquez-García, Yasser B. Abulhasan, Amelia Ain, Amos O. Adeleye, Marcel Aries, Sérgio Brasil, Rafael Badenes, Alessandro Bertuccio, Pierre Bouzat, Luis Bustamante, Lorenzo Calabro’, Hassane Njimi, Danilo Cardim, Giuseppe Citerio, Marek Czosnyka, Thomas Geeraerts, Daniel A. Godoy, Mohammad I. Hirzallah, Bhagavatula Indira Devi, Manuel Jibaja, Piergiorgio Lochner, Julio C. Mijangos Méndez, Geert Meyfroidt, Thangaraj Munusamy, Juan Pinedo Portilla, Hemanshu Prabhakar, Frank Rasulo, Diana M. Sánchez Parra, Aarti Sarwal, Gentle S. Shrestha, Dhaval P. Shukla, Gene Sung, Abenezer Tirsit, Franly Vásquez, Walter Videtta, Yu Lin Wang, Wellingson S. Paiva, Fabio Silvio Taccone, Andres M. Rubiano

Published in: Intensive Care Medicine | Issue 1/2025

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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.
Appendix
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Metadata
Title
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)
Authors
Chiara Robba
Edoardo Picetti
Sebastián Vásquez-García
Yasser B. Abulhasan
Amelia Ain
Amos O. Adeleye
Marcel Aries
Sérgio Brasil
Rafael Badenes
Alessandro Bertuccio
Pierre Bouzat
Luis Bustamante
Lorenzo Calabro’
Hassane Njimi
Danilo Cardim
Giuseppe Citerio
Marek Czosnyka
Thomas Geeraerts
Daniel A. Godoy
Mohammad I. Hirzallah
Bhagavatula Indira Devi
Manuel Jibaja
Piergiorgio Lochner
Julio C. Mijangos Méndez
Geert Meyfroidt
Thangaraj Munusamy
Juan Pinedo Portilla
Hemanshu Prabhakar
Frank Rasulo
Diana M. Sánchez Parra
Aarti Sarwal
Gentle S. Shrestha
Dhaval P. Shukla
Gene Sung
Abenezer Tirsit
Franly Vásquez
Walter Videtta
Yu Lin Wang
Wellingson S. Paiva
Fabio Silvio Taccone
Andres M. Rubiano
Publication date
23-01-2025
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 1/2025
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-024-07756-2