Intracranial multimodal monitoring in neurocritical care (Neurocore-iMMM): an open, decentralized consensus
Sami Barrit, Mejdeddine Al Barajraji, Salim El Hadwe, Alexandre Niset, Brandon Foreman, Soojin Park, Christos Lazaridis, Lori Shutter, Brian Appavu, Matthew P. Kirschen, Felipe A. Montellano, Verena Rass, Nathan Torcida, Daniel Pinggera, Emily J. Gilmore, Nawfel Ben‐Hamouda, Nicolas Massager, Françis Bernard, Chiara Robba, Fabio Silvio Taccone, Mejdeddine Al Barajraji, Ionel Alb, Edilberto Amorim, Brian Appavu, Baptiste Balança, Sami Barrit, Nawfel Ben‐Hamouda, Françis Bernard, Giorgio Carrabba, Russell Chabanne, Giuseppe Citerio, Salim El Hadwe, Brandon Foreman, Emily J. Gilmore, Maria Gonzalez, Adrien Guenego, Steven Hajdu, Raimund Helbok, Peter John Ashton Hutchinson, Kristaps Jurjāns, Matthew P. Kirschen, Alfonso Lagares, Christos Lazaridis, Joshua Mark Levine, Teemu M. Luoto, Niklas Marklund, Nicolas Massager, Aurélien Mazeraud, Mahmoud Messerer, Felipe A. Montellano, Laura B. Ngwenya, Alexandre Niset, Soojin Park, Daniel Pinggera, Verena Rass, Thibault Yves Remacle, Chiara Robba, Sergio Aguilera Rodriguez, Lori Shutter, Fabio Silvio Taccone, Nicole A. Terpolilli, Nathan Torcida Sedano, Parmenion P. Tsitsopoulos, Thomas A. van Essen, Dmitar Vlahovic, Allen Waziri, Jan Willms, Alexander Younsi
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.