• Sami Barrit, Mejdeddine Al Barajraji, El HadweSalimSDepartment of Clinical Neurosciences, University of Cambridge, Cambridge, UK., 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 Gilmore, Nawfel Ben-Hamouda, Nicolas Massager, Francis Bernard, Chiara Robba, Fabio Silvio Taccone, and Neurocore-iMMM Research Group.
• Department of Neurosurgery, CHU Tivoli, Université Libre de Bruxelles, Brussels, Belgium. samibarrit@gmail.com.
• Crit Care. 2024 Dec 20; 28 (1): 427427.

BackgroundIntracranial 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.MethodsAn 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.ResultsAn 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%).ConclusionThis 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.© 2024. The Author(s).

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