Consensus statement from the 2025 Delphi panel on cerebral microdialysis in critical care

PURPOSE: Secondary brain injury is a common cause of poor outcome after trauma, subarachnoid hemorrhage, and intracerebral hemorrhage, and optimizing treatment requires real-time insight into cerebral metabolism. Cerebral microdialysis (CMD) uniquely provides key related information, yet consensus on its use has not been updated since publication of the consensus statement from the 2014 International Microdialysis Forum. We aimed to assess expert consensus on the use of CMD in critical care and provide contemporary guidance to standardize practice and advance clinical implementation. METHODS: We conducted a 3-round modified Delphi study with international experts in CMD and neurocritical care. Consensus was defined as ≥ 75% agreement among non-abstaining respondents, with a minimum of 30 non-abstaining respondents required per statement. Statements not reaching consensus were iteratively revised based on panelist feedback. RESULTS: Forty of 67 invited experts (60%) from 9 countries participated. Sixty of 62 individual items achieved consensus (97%) across 9 domains: indications and patient selection, technical and procedural considerations, detecting deterioration and secondary injury, metabolic interpretation, treatment algorithms, glucose management, sampling frequency, core reporting items, and barriers to clinical implementation. CONCLUSION: This consensus statement provides updated, evidence-informed recommendations for the use of CMD in critical care. The panel reaffirmed many core recommendations from the 2014 consensus while making targeted advances: cautious extension of guidance to intracerebral hemorrhage, comprehensive reporting guidance addressing frequently omitted elements (19 items vs. 6 in 2014), and identification of 10 key barriers to routine clinical adoption.

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Journal
Critical Care
Published
2026-04-13
DOI
https://doi.org/10.1186/s13054-026-05993-z
Primary Topic
Traumatic Brain Injury and Neurovascular Disturbances
Type
article
Field-Weighted Citation Impact
0.00

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article

Consensus statement from the 2025 Delphi panel on cerebral microdialysis in critical care

Patrizio Petrone, Niklas Marklund, Halinder S. Mangat, Emily J. Gilmore et al.
Critical Care
Traumatic Brain Injury and Neurovascular Disturbances
article

Consensus statement from the 2025 Delphi panel on cerebral microdialysis in critical care

Patrizio Petrone, Niklas Marklund, Halinder S. Mangat, Emily J. Gilmore, Raimund Helbok, Ibrahim Jalloh, Chisomo Zimphango, Ivan Timofeev, Jonathan Coles, Aoife Quinn, Juan Sahuquillo, Anthony J. Strong, Matthew G. Stovell, Maria Antonia Poca, Antonio Belli, Martyn G. Boutelle, Keri L.H. Carpenter, Ava M. Puccio, David Krishna Menon, Sandra Magnoni, Paul Vespa, Virginia Newcombe, Alex B. Valadka, Brandon Foreman, Claudia Sue Robertson, Neeraj Badjatia, J S Chen, Patrick M. Chen, Adel Helmy, Mauro Oddo, David Nelson, Claire Dahyot‐Fizelier, Jan Claassen, Peter D. LeRoux, K. O’Phelan, Teodor Svedung Wettervik, Ari Ercole, Sara Venturini, Ramon Torné, Elham Rostami, Louise Roberts, Clare Gallagher, Peter John Hutchinson, Arun K. Gupta, M. Ross Bullock, Eric P. Thelin, Michael S. Baker
article en

Abstract

PURPOSE: Secondary brain injury is a common cause of poor outcome after trauma, subarachnoid hemorrhage, and intracerebral hemorrhage, and optimizing treatment requires real-time insight into cerebral metabolism. Cerebral microdialysis (CMD) uniquely provides key related information, yet consensus on its use has not been updated since publication of the consensus statement from the 2014 International Microdialysis Forum. We aimed to assess expert consensus on the use of CMD in critical care and provide contemporary guidance to standardize practice and advance clinical implementation. METHODS: We conducted a 3-round modified Delphi study with international experts in CMD and neurocritical care. Consensus was defined as ≥ 75% agreement among non-abstaining respondents, with a minimum of 30 non-abstaining respondents required per statement. Statements not reaching consensus were iteratively revised based on panelist feedback. RESULTS: Forty of 67 invited experts (60%) from 9 countries participated. Sixty of 62 individual items achieved consensus (97%) across 9 domains: indications and patient selection, technical and procedural considerations, detecting deterioration and secondary injury, metabolic interpretation, treatment algorithms, glucose management, sampling frequency, core reporting items, and barriers to clinical implementation. CONCLUSION: This consensus statement provides updated, evidence-informed recommendations for the use of CMD in critical care. The panel reaffirmed many core recommendations from the 2014 consensus while making targeted advances: cautious extension of guidance to intracerebral hemorrhage, comprehensive reporting guidance addressing frequently omitted elements (19 items vs. 6 in 2014), and identification of 10 key barriers to routine clinical adoption.

Critical Care
University of Messina (IT), Johannes Kepler University of Linz (AT), Hebron University (PS), Universitat Autònoma de Barcelona (ES), Uppsala University (SE), University of Maryland, Baltimore (US), Karolinska University Hospital (SE), NewYork–Presbyterian Hospital (US), Uppsala University Hospital (SE), Long Island University (US), University of Miami (US), University of Liverpool (GB), Inserm (FR), University of Sassari (IT), University of California, Los Angeles (US), University of Calgary (CA), University of Pittsburgh (US), Baylor College of Medicine (US), King's College London (GB), Lund University (SE), University of California, Irvine (US), University of Cambridge (GB), Columbia University Irving Medical Center (US), Cambridge University Hospitals NHS Foundation Trust (GB), Walton Centre (GB), Karolinska Institutet (SE), Université de Poitiers (FR), Yale University (US), Cambridge School (PT), NIHR Birmingham Liver Biomedical Research Unit (GB), Vall d'Hebron Institut de Recerca (ES), Centre Hospitalier Universitaire de Poitiers (FR), Hospital Clínic de Barcelona (ES), Vall d'Hebron Hospital Universitari (ES), University of Kansas Medical Center (US), Acquired Brain Injury Ireland (IE), Skåne University Hospital (SE), Bassett Healthcare Network (US), Neurological Surgery (US), NIHR Birmingham Biomedical Research Centre (GB), Hotchkiss Brain Institute (CA), Imperial College London (GB), University of Cincinnati (US), All India Institute of Medical Sciences (IN), University of Birmingham (GB), The University of Texas Southwestern Medical Center (US), University of Lausanne (CH)
Medical Research Council, NIHR Cambridge Biomedical Research Centre
Openalex Percentile: Top 19%
Traumatic Brain Injury and Neurovascular Disturbances
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