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World J Crit Care Med. Sep 9, 2025; 14(3): 105645
Published online Sep 9, 2025. doi: 10.5492/wjccm.v14.i3.105645
Management of intracranial hypertension with and without invasive intracranial pressure monitoring
Larissa Bianchini, Paulo Marcelo Pontes Gomes de Matos, Roberta Muriel Longo Roepke, Bruno Adler Maccagnan Pinheiro Besen
Larissa Bianchini, Paulo Marcelo Pontes Gomes de Matos, Bruno Adler Maccagnan Pinheiro Besen, Medical Sciences Postgraduate Programme, Internal Medicine Department, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403-010, Brazil
Larissa Bianchini, Paulo Marcelo Pontes Gomes de Matos, Bruno Adler Maccagnan Pinheiro Besen, Intensive Care Unit, Department of Medicine, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403-010, Brazil
Larissa Bianchini, Hcor Research Institute, HCOR, Sao Paulo 04004-030, Brazil
Roberta Muriel Longo Roepke, Trauma and Acute Care Surgery ICU, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 05403-010, Brazil
Bruno Adler Maccagnan Pinheiro Besen, IDOR Research and Education Institute, IDOR Research and Education Institute, Sao Paulo 01401-002, Brazil
Author contributions: Bianchini L conceptualization, literature search, and drafting of the original manuscript; Matos PMPG literature search, and drafting of the original manuscript; Roepke RML provided project oversight and contributed to the final revision; Besen BAMP contributed to the study design, supervised the project, and revised the manuscript critically. All authors reviewed and approved the final version of the manuscript.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Larissa Bianchini, MD, Medical Sciences Postgraduate Programme, Internal Medicine Department, Faculdade de Medicina, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 225, Sao Paulo 05403-010, Brazil. larissa_bianchini@hotmail.com
Received: February 2, 2025
Revised: April 1, 2025
Accepted: April 15, 2025
Published online: September 9, 2025
Processing time: 167 Days and 19.4 Hours
Core Tip

Core Tip: Intracranial hypertension (IH) is one of the most critical syndromes in critical care medicine. Its management is classically guided by invasive intracranial pressure (ICP) monitoring, although recent evidence has questioned the value of invasive ICP monitoring while advances in noninvasive assessment of cerebral dynamics have evolved. In this manuscript, we guide the readers through the recent evidence base, we critically discuss the literature and we provide suggested guidance to the management of IH with and without invasive ICP monitoring.