Evidence map›Paper›PMID 39847066›Full record

ArticleIntensive care medicine2025

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 and 31 more

Registry-linked trialAbstract readConsensus Statement
PubMed Publisher
In one paragraph

Article in Intensive care medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07786324 (Comparison of 3% Hypertonic Saline Versus 20% Mannitol in Reduction of Increased Intracranial Pressure in Patients With Traumatic Brain Injury Using Optic Nerve Sheath Diameter Measurements''), which is not on this map. Cited by 42 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
42citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07786324 nanot yet recruitingnot on this mapstarted 2026, after this paper: background citation

Comparison of 3% Hypertonic Saline Versus 20% Mannitol in Reduction of Increased Intracranial Pressure in Patients With Traumatic Brain Injury Using Optic Nerve Sheath Diameter Measurements''

TypeinterventionalSponsorAssiut UniversityRan2026 to 2029Enrolled100ConditionsTBI (Traumatic Brain Injury), ICP (Intracranial Pressure) Increase, Optic Nerve Sheath Diameter MeasurementArmsMannitol (20%), Hypertonic Saline ( 3% Sodium Chloride Saline)
3 · Its place in the literature

Who cites it

42 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Guideline
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  4. Observational
  5. Review
  6. Article
  7. A comparison between two indices derived from automated pupillometry devices.Journal of clinical monitoring and computing · 2026
    Article
  8. Article
  9. Dynamic response of optic nerve sheath diameter to PaCOJournal of clinical monitoring and computing · 2026
    Article
  10. Review
  11. Article
  12. Article
  13. Article
  14. Review
  15. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

41 authors.

Chiara Robba *IRCCS Ospedale Policlinico San Martino, Genoa, Italy. kiarobba@gmail.com.ORCID 0000-0003-1628-3845
Edoardo Picetti *Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy.
Sebastián Vásquez-García *Neurosciences and Intensive Care Department, Clínica del Country, Bogotá, Colombia.
Yasser B AbulhasanFaculty of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait.
Amelia AinDepartment of Anesthesiology and Intensive Care, Hospital Sultan Abdul Halim, Kedah, Malaysia.
Amos O AdeleyeDivision of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Marcel AriesDepartment of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
Sérgio BrasilDepartment of Neurology, University of São Paulo, São Paulo, Brazil.
Rafael BadenesDepartment of Surgery, University of Valencia, Valencia, Spain.
Alessandro BertuccioDepartment of Neurosurgery, St. Antonio and Biagio and Cesare Arrigo Hospital, Neurosurgery Unit, Alessandria, Italy.
Pierre BouzatCentre Hospitalier Universitaire Grenoble Alpes, Grenoble Institut des Neurosciences, Pôle Anesthésie Réanimation, Grenoble Alpes University, Grenoble, France.
Luis BustamanteUniversidad Pontificia Javeriana, Cali, Colombia.
Lorenzo Calabro'Department of Intensive Care, Hospital Erasme, Universitè Libre De Bruxelles, Brussels, Belgium.
Hassane NjimiDepartment of Intensive Care, Hospital Erasme, Universitè Libre De Bruxelles, Brussels, Belgium.
Danilo CardimDepartment of Neurology, University of Texas Southwestern Medical Center, Dallas, USA.
Giuseppe CiterioSchool of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
Marek CzosnykaDivision of Neurosurgery, Department of Clinical Neurosciences, Brain Physics Laboratory, University of Cambridge, Cambridge, UK.
Thomas GeeraertsPôle Anesthésie-Réanimation, Inserm, UMR 1214, Toulouse Neuroimaging Center, ToNIC, Université Toulouse 3-Paul Sabatier, CHU de Toulouse, 31059, Toulouse, France.
Daniel A GodoyDepartamento Medicina Critica, Unidad de Cuidados Neurointensivos, Sanatorio Pasteur, Catamarca, Argentina.
Mohammad I HirzallahDepartment of Neurology, Baylor College of Medicine, Houston, TX, USA.
Bhagavatula Indira DeviDepartment of Neurosurgery, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India.
Manuel JibajaHospital Eugenio Espejo and Escuela de Medicina de la Universidad San Francisco de Quito, Quito, Ecuador.
Piergiorgio LochnerDepartment of Neurology, Saarland University Medical Center, Homburg, Germany.
Julio C Mijangos MéndezUnidad de Terapia Intensiva, Hospital Civil Fray Antonio Alcalde, Universidad de Guadalajara, Coronel Calderón 777, El Retiro, Guadalajara, Jalisco, Mexico.
Geert MeyfroidtDepartment and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU, Louvain, Belgium.
Thangaraj MunusamyDepartment of Neurosurgery, Singapore General Hospital, Singapore, Singapore.
Juan Pinedo PortillaUnidad de Cuidados Intensivos, Clinicas AUNA, Chiclayo, Peru.
Hemanshu PrabhakarDepartment of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
Frank RasuloDepartment of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
Diana M Sánchez ParraUniversity of Medical Sciences of Havana, Havana, Cuba.
Aarti SarwalDepartment of Neurology, Cooper Medical School of Rowan University, Camden, NJ, USA.
Gentle S ShresthaDepartment of Anesthesiology, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.
Dhaval P ShuklaDepartment of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India.
Gene SungUniversity of Southern California, Los Angeles, USA.
Abenezer TirsitNeurosurgery Division, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Franly VásquezHospital Dr. Darío Contreras, Santo Domingo, República Dominicana.
Walter VidettaHospital Nacional Professor Alejandro Posadas, Buenos Aires, Argentina.
Yu Lin WangNeuro Intensive Care Unit, Tan Tock Seng Hospital, Singapore, Singapore.
Wellingson S PaivaDepartment of Neurosurgery, University of São Paulo, São Paulo, Brazil.
Fabio Silvio Taccone *Department of Intensive Care, Hospital Erasme, Universitè Libre De Bruxelles, Brussels, Belgium.
Andres M Rubiano *Global Health Research Group in Acquired Brain and Spine Injuries, Cambridge, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

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.

Indexed as

Brain Injuries, TraumaticIntracranial PressureAlgorithmsDelphi TechniqueHumansMonitoring, PhysiologicAutomated pupillometryNon-invasive intracranial pressureOptic nerve sheath diameterTranscranial DopplerTraumatic brain injury

Identifiers

PMID39847066

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.