Traumatic brain injury management in the intensive care unit: standard of care and knowledge gaps.

Journal: Intensive care medicine
Published Date: Jun 16, 2025

Abstract

Despite advances in the management of traumatic brain injury (TBI) in the intensive care unit (ICU), and the implementation of new diagnostic techniques and monitoring modalities, the rate of poor neurological outcomes remains high. Specialized neurocritical care units have been shown to improve outcomes. Guidelines have been developed, but most recommendations are based on low levels of evidence. This has led to substantial heterogeneity in clinical practice for many aspects of TBI management, including multimodal neuromonitoring indications, treatment of intra- and extra-cranial complications, and use of prognostic tools. New tools have recently emerged, such as biomarkers and the use of artificial intelligence, but further research is needed to establish their application in clinical practice. This narrative review aims to describe standards of practice for the management of TBI in the ICU, highlighting current evidence and knowledge gaps, to provide a pragmatic approach for clinicians caring for this population.

Authors

  • Chiara Robba
    Department of Anesthesiology and Intensive Care, San Martino Policlinico Hospital, Genoa, Italy.
  • Victoria McCredie
    Interdepartmental Division of Critical Care Medicine, University of Toronto, Critical Care and Neurocritical Care Medicine, Toronto Western Hospital, Division of University Health Network, Krembil Research Institute, Toronto, Canada.
  • Randall M Chesnut
    Department of Neurological Surgery, University of Washington, Seattle, USA.
  • Giuseppe Citerio
    University of Milan-Bicocca, School of Medicine and Surgery and Department of Emergency and Intensive Care, Monza, Italy.
  • Tobias Gauss
    Anesthesia and Critical Care, Grenoble Alpes, University Hospital, Grenoble, France.
  • Gregory W J Hawryluk
    Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, USA.
  • Raimund Helbok
    Department of Neurology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria.
  • Geert Meyfroidt
    Department of Intensive Care Medicine, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium.
  • Virginia Newcombe
    Department of Medicine, University of Cambridge, Cambridge, UK.
  • Aarti Sarwal
    Department of Neurology, Wake Forest Baptist Medical Center, Winston Salem, NC, USA.
  • Fabio S Taccone
    Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium.
  • Mathieu van der Jagt
    Department of Intensive Care Adults, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
  • Sarah Wahlster
    Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA, USA.
  • Elisa R Zanier
    Department of Acute Brain and Cardiovascular Injury, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
  • Pierre Bouzat
    Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble Institut Neurosciences (GIN), U1216, Eq. "Neuroimagerie Fonctionnelle et Perfusion Cérébrale", 38700, Grenoble, France.

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