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).

Summary

An international expert panel synthesized evidence through scoping and systematic reviews with meta-analyses and, via a Delphi process, issued 34 recommendations (32 strong) and practical algorithms for non-invasive ICP-guided care in TBI when invasive monitoring is unavailable.

Key Findings

• Developed 34 recommendations (32 strong, 2 weak) for nICP use in TBI across three domains.
• Created four escalation algorithms and de-escalation heatmaps based on nICP thresholds.
• Recommendations derived from three scoping and four systematic reviews with meta-analyses and a modified Delphi process.

Clinical Implications

Clinicians can implement structured nICP-based thresholds to escalate/de-escalate ICP therapies when invasive monitoring is not feasible, integrating clinical exam and imaging when available.

Limitations

• Consensus-based recommendations require prospective validation in diverse settings
• Heterogeneity and variable accuracy among nICP technologies

Future Directions

Prospective multicentre validation of nICP thresholds and algorithms against patient-centered outcomes and, where possible, invasive ICP benchmarks.