• Intensive care medicine · Jan 2025

    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).

    • 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, DeviBhagavatula IndiraBIDepartment of Neurosurgery, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India., 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, and Andres M Rubiano.
    • IRCCS Ospedale Policlinico San Martino, Genoa, Italy. kiarobba@gmail.com.
    • Intensive Care Med. 2025 Jan 1; 51 (1): 4204-20.

    BackgroundInvasive 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.MethodsA 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%.ResultsA 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.ConclusionsUsing 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.© 2025. Springer-Verlag GmbH Germany, part of Springer Nature.

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