To: Neurocritical care management supported by multimodal brain monitoring after acute brain injury

Editor We read with interest the article by Monteiro et al. on a retrospective single-center study of the outcomes and mortality of 389 patients with traumatic brain injury (TBI) or subarachnoid bleeding (SAB) depending on the level of neuro-monitoring (standard, advanced) in a neuro-critical care unit (NCCU, Group G1) and a general intensive care unit (ICU) (GICU, Group G2). (1) The severity of the disease was assessed at admission to the emergency department using the simplified acute physiology (SAPS) II score. (1) Advanced multimodal brain monitoring, including autoregulation and NCCU management, was associated with better outcomes than standard neuromonitoring in the GICU. (1) The study is impressive, but some points require discussion. The major limitation of the study is that factors other than ICU monitoring and ICU type were not adequately included in the evaluation. The outcomes of TBI and SAB depend not only on the type and quality of neuro-monitoring in the ICU but also on several other influencing factors. These include the type and severity of TBI and SAB, the treatment of TBI and SAB, comorbidities, comedication, family history, and genetic background. In addition, for patients with SAB, it must be clarified whether the bleeding is aneurysmal or non-aneurysmal. In the case of an aneurysm, it is important to know whether the aneurysm is coiled or resected. The outcome of SAB may also depend on the initial Hunt–Hess score and whether there is blood inside the ventricles as well as age, comorbidities,