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

Chiara Robba; Victoria McCredie; Randall M Chesnut; Giuseppe Citerio; Tobias Gauss; Gregory W J Hawryluk; Raimund Helbok; Geert Meyfroidt; Virginia Newcombe; Aarti Sarwal; Fabio S Taccone; Mathieu van der Jagt; Sarah Wahlster; Elisa R Zanier; Pierre Bouzat

doi:10.1007/s00134-025-07967-1

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

Intensive Care Med. 2025 Jun 16. doi: 10.1007/s00134-025-07967-1. Online ahead of print.

Authors

Chiara Robba^{1

2}, Victoria McCredie³, Randall M Chesnut⁴, Giuseppe Citerio^{5

6}, Tobias Gauss⁷, Gregory W J Hawryluk⁸, Raimund Helbok^{9

10}, Geert Meyfroidt¹¹, Virginia Newcombe¹², Aarti Sarwal¹³, Fabio S Taccone¹⁴, Mathieu van der Jagt¹⁵, Sarah Wahlster¹⁶, Elisa R Zanier¹⁷, Pierre Bouzat⁷

Affiliations

¹ Department of Surgical Science and Integrated Diagnostic, University of Genova, Genoa, Italy. kiarobba@gmail.com.
² IRCCS Ospedale Policlinico San Martino, Genoa, Italy. kiarobba@gmail.com.
³ 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.
⁴ Department of Neurological Surgery, University of Washington, Seattle, USA.
⁵ School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
⁶ Department of Neuroscience, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
⁷ Univ. Grenoble Alpes, Grenoble Institute of Neurosciences, INSERM U1216, Department of Anesthesiology and Intensive Care Medicine, Grenoble Alps University Hospital, Grenoble, France.
⁸ Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, USA.
⁹ Department of Neurology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria.
¹⁰ Clinical Research Institute for Neuroscience, Johannes Kepler University Linz, Linz, Austria.
¹¹ Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Leuven, Belgium.
¹² Department of Medicine, University of Cambridge, Cambridge, UK.
¹³ Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, USA.
¹⁴ Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium.
¹⁵ Department of Intensive Care Adults, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
¹⁶ Departments of Neurology, Neurosurgery, and Anesthesiology, University of Washington, Seattle, USA.
¹⁷ Department of Acute Brain and Cardiovascular Injury, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.

PMID: 40522481
DOI: 10.1007/s00134-025-07967-1

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.

Keywords: Biomarkers; Intensive care medicine; Outcomes; Secondary brain injury; Traumatic brain injury.

Publication types

Review