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

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.