Review

. 2024 Dec 20;28(1):427.

doi: 10.1186/s13054-024-05211-8.

Intracranial multimodal monitoring in neurocritical care (Neurocore-iMMM): an open, decentralized consensus

Sami Barrit¹, Mejdeddine Al Barajraji², Salim El Hadwe³, Alexandre Niset⁴, Brandon Foreman⁵, Soojin Park⁶, Christos Lazaridis⁷, Lori Shutter⁸, Brian Appavu⁹, Matthew P Kirschen¹⁰, Felipe A Montellano¹¹, Verena Rass¹², Nathan Torcida¹³, Daniel Pinggera¹⁴, Emily Gilmore¹⁵, Nawfel Ben-Hamouda¹⁶, Nicolas Massager¹⁷, Francis Bernard¹⁸, Chiara Robba¹⁹, Fabio Silvio Taccone²⁰; Neurocore-iMMM Research Group

Collaborators, Affiliations

Collaborators

Neurocore-iMMM Research Group:
Mejdeddine Al Barajraji, Ionel Alb, Edilberto Amorim, Brian Appavu, Baptiste Balanca, Sami Barrit, Nawfel Ben-Hamouda, Francis Bernard, Giorgio Giovanni Carrabba, Russell Chabanne, Giuseppe Citerio, Salim El Hadwe, Brandon Foreman, Emily Gilmore, Maria Isabel Gonzalez, Adrien Guenego, Steven David Hajdu, Raimund Helbok, Peter John Ashton Hutchinson, Kristaps Jurjans, Matthew P Kirschen, Alfonso Lagares, Christos Lazaridis, Joshua Mark Levine, Teemu M Luoto, Niklas Marklund, Nicolas Massager, Aurélien Mazeraud, Mahmoud Messerer, Felipe Montellano, Laura Benjamin Ngwenya, Alexandre Niset, Soojin Park, Daniel Pinggera, Verena Rass, Thibault Yves Remacle, Chiara Robba, Sergio Aguilera Rodriguez, Lori Shutter, Fabio Silvio Taccone, Nicole Angela Terpolilli, Nathan Torcida Sedano, Parmenion P Tsitsopoulos, Thomas Arjan Van Essen, Dmitar Vlahovic, Allen Waziri, Jan Folkard Willms, Alexander Younsi

Affiliations

¹ Department of Neurosurgery, CHU Tivoli, Université Libre de Bruxelles, Brussels, Belgium. samibarrit@gmail.com.
² Department of Neurosurgery, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland. mejdi@sciense.org.
³ Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
⁴ Pediatric Intensive Care Unit, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
⁵ Department of Neurology and Rehabilitation, University of Cincinnati, Cincinnati, OH, USA.
⁶ Department of Neurology, New York Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.
⁷ Section of Neurocritical Care, Departments of Neurology and Neurosurgery, The University of Chicago, Chicago, IL, USA.
⁸ Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
⁹ Department of Neurology, Phoenix Children's, Phoenix, AZ, USA.
¹⁰ Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
¹¹ Department of Neurology, University Hospital Würzburg, Würzburg, Germany.
¹² Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
¹³ Department of Neurology, Hôpital Universitaire de Bruxelles, HUB, Brussels, Belgium.
¹⁴ Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria.
¹⁵ Department of Neurology, Yale University, New Haven, CT, USA.
¹⁶ Department of Adult Intensive Care Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
¹⁷ Department of Neurological Surgery, CHU Tivoli, La Louvière, Belgium.
¹⁸ Section of Critical Care, Department of Medicine, University of Montreal, Montreal, QC, Canada.
¹⁹ IRCCS Policlinico San Martino, Genoa, Italy.
²⁰ Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.

PMID: 39707556
PMCID: PMC11660549
DOI: 10.1186/s13054-024-05211-8

Review

Intracranial multimodal monitoring in neurocritical care (Neurocore-iMMM): an open, decentralized consensus

Sami Barrit et al. Crit Care. 2024.

. 2024 Dec 20;28(1):427.

doi: 10.1186/s13054-024-05211-8.

Authors

Collaborators

Neurocore-iMMM Research Group:
Mejdeddine Al Barajraji, Ionel Alb, Edilberto Amorim, Brian Appavu, Baptiste Balanca, Sami Barrit, Nawfel Ben-Hamouda, Francis Bernard, Giorgio Giovanni Carrabba, Russell Chabanne, Giuseppe Citerio, Salim El Hadwe, Brandon Foreman, Emily Gilmore, Maria Isabel Gonzalez, Adrien Guenego, Steven David Hajdu, Raimund Helbok, Peter John Ashton Hutchinson, Kristaps Jurjans, Matthew P Kirschen, Alfonso Lagares, Christos Lazaridis, Joshua Mark Levine, Teemu M Luoto, Niklas Marklund, Nicolas Massager, Aurélien Mazeraud, Mahmoud Messerer, Felipe Montellano, Laura Benjamin Ngwenya, Alexandre Niset, Soojin Park, Daniel Pinggera, Verena Rass, Thibault Yves Remacle, Chiara Robba, Sergio Aguilera Rodriguez, Lori Shutter, Fabio Silvio Taccone, Nicole Angela Terpolilli, Nathan Torcida Sedano, Parmenion P Tsitsopoulos, Thomas Arjan Van Essen, Dmitar Vlahovic, Allen Waziri, Jan Folkard Willms, Alexander Younsi

Affiliations

¹ Department of Neurosurgery, CHU Tivoli, Université Libre de Bruxelles, Brussels, Belgium. samibarrit@gmail.com.
² Department of Neurosurgery, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland. mejdi@sciense.org.
³ Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
⁴ Pediatric Intensive Care Unit, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
⁵ Department of Neurology and Rehabilitation, University of Cincinnati, Cincinnati, OH, USA.
⁶ Department of Neurology, New York Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.
⁷ Section of Neurocritical Care, Departments of Neurology and Neurosurgery, The University of Chicago, Chicago, IL, USA.
⁸ Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
⁹ Department of Neurology, Phoenix Children's, Phoenix, AZ, USA.
¹⁰ Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
¹¹ Department of Neurology, University Hospital Würzburg, Würzburg, Germany.
¹² Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
¹³ Department of Neurology, Hôpital Universitaire de Bruxelles, HUB, Brussels, Belgium.
¹⁴ Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria.
¹⁵ Department of Neurology, Yale University, New Haven, CT, USA.
¹⁶ Department of Adult Intensive Care Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
¹⁷ Department of Neurological Surgery, CHU Tivoli, La Louvière, Belgium.
¹⁸ Section of Critical Care, Department of Medicine, University of Montreal, Montreal, QC, Canada.
¹⁹ IRCCS Policlinico San Martino, Genoa, Italy.
²⁰ Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.

PMID: 39707556
PMCID: PMC11660549
DOI: 10.1186/s13054-024-05211-8

Abstract

Background: Intracranial multimodal monitoring (iMMM) is increasingly used in neurocritical care, but a lack of standardization hinders its evidence-based development. Here, we devised core outcome sets (COS) and reporting guidelines to harmonize iMMM practices and research.

Methods: An open, decentralized, three-round Delphi consensus study involved experts between December 2023 and June 2024. Items-spanning three domains: (i) patient characteristics, (ii) practices, and (iii) outcomes-with ≥ 75% agreement were classified as strong agreement, while those with 50-75% were reconsidered in subsequent rounds, requiring ≥ 66% for moderate agreement.

Results: An international, multidisciplinary panel comprised 58 neurocritical physicians and researchers with low attrition (12%). They were predominantly from Western regions (96%), actively involved in iMMM (82%), at least weekly (72.4%), with more than 10 years of specific experience (57%). Of the 127 items assessed for inclusion in COS and reporting guidelines, 45 (35.4%) reached strong and 8 (6.3%) moderate agreement. Main strong agreement items were: (i) demographics: age (98%) and sex/gender (90%); comorbidities: coagulation/platelet disorders (95%); initial scoring: Glasgow Coma Scale (97%) and pathology-specific scores (90%); active treatments: antithrombotics (95%) (ii) clinical practice: iMMM implantation indications (98%) and iMMM-guided interventions (91%); surgical practice: targeting strategies (97%) and concomitant external ventricular drainage (97%); technical details: recording modalities (98%); (iii) monitoring parameters: duration (97%) and triggered interventions (95%); standardized outcome reporting (93%); surgical complications (e.g., postoperative intracranial hemorrhages, CNS infections, and probe misplacement, all > 90%) and adverse events (accidental dislodgement, probe breakage, and technical malfunctions, all > 90%).

Conclusion: This consensus establishes foundational COS and reporting guidelines for iMMM in neurocritical care. These harmonization tools can enhance research quality, comparability, and reproducibility, facilitating evidence-based practices for this emerging technology. However, challenges remain in developing purpose-specific guidelines and adapting them to diverse clinical and research settings.

Keywords: Brain tissue oxygenation; ICP; Intracranial multimodal monitoring; Intracranial pressure; MNM; Microdialysis; Multimodal neuromonitoring; Neurocritical care; Pbto2; iMMM.

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Conflict of interest statement

Declarations. Ethical approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: EA has received grants from the NIH, American Heart Association, Zoll Foundation, US Department of Defense, and Cures Within Reach. BA has received grants from NIH and the Pediatric Epilepsy Research Foundation (payment to the institution) and speaking honoraria from Natus and ASET. BB received speaking honoraria from Natus on multimodal neuro monitoring. SB disclosed being the founder of an organization for open and decentralized research, Sciense.org. MAB is a member of the Sciense initiative. FB reported lecture honoraria from Integra Life Science, participation in Elastic Trail DSMB, and receiving equipment from Massimo through a grant to build a data lake. RC received personal fees for expert testimony from Sophysa and is a member of the executive committee of the Neurocritical Care and Neuro Anesthesiology French Speaking Society (ANARLF). BF disclosed grants from the Department of Defense, consulting fees from UCB Pharma and Ceribell, lecture honoraria from UCB Pharma, Natus Medical Inc., Marinus Pharmaceuticals, and Ceribell, participation on advisory boards for Sage Therapeutics and Marinus Pharmaceuticals, and unpaid leadership roles in the Curing Coma Campaign and the American Clinical Neurophysiology Society. EG received NIH funding for the ELECTRO-BOOST trial (R01-NS117904-01) while serving on the NORSE Medical & Scientific Board. RH has consulting fees from Integra and received payments for lectures from Integra, Zoll, and BD. CL received grants from the Department of Defense for the study on the Prediction and Prevention of Intracranial Hypertension and Tissue Hypoxia in severe TBI (GRANT13518109). JL disclosed royalties from Elsevier and UpToDate and has received payments for expert testimony from Buchanan Ingersoll & Rooney PC and Younker Hyde Macfarlane PLLC. FAM is supported by the German Research Foundation (DFG). SP serves as an Associate Editor for Neurocritical Care and a Board Trustee for the Neurocritical Care Foundation. LS holds the position of Secretary for the Neurocritical Care Society. FST received advisor fees from NEUROPTICS and NIHON KHODEN. TVE disclosed grants from the EANS Clinical Research Fund, Hersenstichting (Dutch Brain Foundation) for CIAO-TBI, and Dalhousie University Operational Grant. AW is a stockholder in iCE Neurosystems, and AY received honoraria from Raumedic AG for lectures.

References

1. Barrit S, El Hadwe S, Al Barajraji M, Torcida N, Bogossian EG, André J, et al. Complications of intracranial multimodal monitoring for neurocritical care: a systematic review and meta-analysis. Neurocrit Care. 2024;40(3):1182–92. - PubMed
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Intracranial multimodal monitoring in neurocritical care (Neurocore-iMMM): an open, decentralized consensus

Collaborators

Affiliations

Intracranial multimodal monitoring in neurocritical care (Neurocore-iMMM): an open, decentralized consensus

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical