Monitoring intracranial pressure (ICP), alongside factors like brain tissue oxygenation, metabolism, and electrical activity, is crucial in neurocritical care. Over the past two centuries, research has highlighted the importance of balancing intracranial compartment volumes to maintain cerebral function. Elevated ICP, in particular, reduces cerebral blood perfusion and disrupts the regulation of cerebral blood flow. While the gold standard for ICP monitoring has traditionally involved invasive probes placed in the brain's ventricles or parenchyma, these methods require specialized personnel, come at significant cost, and involve risks inherent to invasive procedures. In response, a new technology has emerged, offering a more accurate means of measuring ICP without the invasiveness of current methods.

A collaborative study involving researchers from the University of São Paulo (São Paulo, Brazil) studied the technology developed by brain4care (Johns Creek, GA, USA). The system utilizes a sensor placed on the patient's head, which detects nanometric expansions of the skull during each cardiac cycle. This data is then processed in real-time through an artificial intelligence (AI) platform that generates reports to assist clinicians in decision-making. A key distinction in brain4care's approach is its analysis of ICP, which includes not just the numerical value, but also the trend (upward or downward) and the pulse morphology, the way pressure changes over time. Unlike traditional methods, which focus primarily on numerical values, this system evaluates the pulse's behavior, enabling early detection of changes even before they are reflected in pressure readings.

In developing the system, the company’s researchers also translated the ICP pulse into numbers which allow the physician to monitor the patient’s status by tracking trends. This allows doctors to identify neurological changes early, enabling faster, more accurate interventions that can be life-saving in critical situations. The latest study, which involved the largest patient cohort to date, demonstrated that this technology exhibited the lowest error rate in estimating ICP compared to any other available non-invasive methods globally. Using a machine learning model, the study, published in npj Digital Medicine, achieved an error margin of just 3 millimeters of mercury, a common unit for ICP measurement, across more than 100 patients. Unlike the invasive ICP monitoring method, which requires a patient to be taken to the operating room for device placement, brain4care’s technology can be used anywhere.

This portability is one of the key benefits, as it allows the device to be used not only in ICUs but also in outpatient clinics, emergency departments, and even smaller medical settings. This significantly expands access to ICP monitoring, which is crucial in cases such as head trauma, where rapid diagnosis and treatment can determine whether brain function is preserved. Additionally, brain4care’s system is user-friendly, requiring no complex training, making it easier to implement across diverse healthcare environments. Present in over 85 institutions across Brazil, including major hospitals in São Paulo and rural charity hospitals, this widespread use shows the system’s adaptability to various contexts. The technology has already received approval from Brazil’s National Health Surveillance Agency (ANVISA) and the U.S. Food and Drug Administration (FDA).

“I always say that we’re not going to replace invasive ICP, but we will be able to determine who really needs it,” said Gustavo Frigieri, scientific director of brain4care and one of the authors of the study. “We want to make sure that the majority of patients are treated before they become critical, but that those who need this type of intervention can receive it safely. At the same time, this will help to optimize the use of resources.” 

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