• Sérgio Brasil, Daniel A Godoy, and Wellingson S Paiva.
• Division of Neurosurgery, Department of Neurology, School of Medicine University of São Paulo, São Paulo, Brazil. Electronic address: sbrasil@usp.br.
• World Neurosurg. 2023 Oct 1; 178: 939593-95.

BackgroundIntracranial pressure (ICP) management based on predetermined thresholds is not accurate in light of recent research on cerebrovascular physiology. Interpersonal and intrapersonal variations will lead ICP elevations to reach individualized thresholds for intracranial compliance impairment from one subject to another. Therefore reuniting the modern techniques of neuromonitoring besides ICP enables practitioners to have a more whole picture in anticipating neuro worsening and improving timing in decision making.MethodsBrief literature review.ResultsFor the severely brain-injured patient, current evidence indicates a personalized and physiology-based multimodal monitoring care to be required rather than decision making according to ICP predetermined cut-offs.ConclusionsThe authors' point of view is of particular importance for regions with resource heterogeneity and scarcity, where ICP monitoring is not available for all those in need and noninvasive techniques may provide a surrogate approach. If physicians who deal with acute-brain-injured patients in lower-resource areas understand that several tools besides ICP may improve their practice, it is possible to reduce acute brain injury morbimortality.Copyright © 2023 Elsevier Inc. All rights reserved.

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