Neurocritical care management for severe brain injuries (SBI) has traditionally focused on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring and treatment to prevent brain herniation and ischemia. However, the complex pathophysiology of secondary brain injury in SBI patients involves various mechanisms, including oxygen metabolism and transport disturbances, mitochondrial dysfunction, and signaling cascade disruption. Multimodal neuromonitoring (MMN) techniques and modern high-technology resources are being utilized to detect these detrimental phenomena and guide individualized clinical management strategies. Recent and ongoing clinical trials, mainly in traumatic brain injury (TBI), aim to assess the potential benefits, safety, reproducibility, and feasibility of adding cerebral tissue oximetry monitoring (CTOM) to the common practice of ICP monitoring. This state-of-the-art review highlights the essential concepts behind CTOM in patients with SBI, particularly in TBI, and provides practice-oriented analysis and considerations for healthcare providers managing these complex patients.
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