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Accurate assessment of secondary brain injuries severity is pivotal for tailor adequate therapies in such patients. Together with neurological examination and brain imaging, monitoring of systemic secondary brain injuries is relatively straightforward and should be implemented in all patients, according to local resources. Cerebral secondary injuries involve factors like brain compliance loss, tissue hypoxia, seizures, metabolic disturbances and neuroinflammation. In this viewpoint, we have considered the combination of specific noninvasive and invasive monitoring tools to better understand the mechanisms behind the occurrence of these events and enhance treatment customization, such as intracranial pressure monitoring, brain oxygenation assessment and metabolic monitoring. These tools enable precise intervention, contributing to improved care quality for severe brain injury patients. The future entails more sophisticated technologies, necessitating knowledge, interdisciplinary collaboration and resource allocation, with a focus on patient-centered care and rigorous validation through clinical trials.<\/jats:p>","DOI":"10.1186\/s13054-024-04893-4","type":"journal-article","created":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T15:01:52Z","timestamp":1711983712000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["\u201cNeuroVanguard\u201d: a contemporary strategy in neuromonitoring for severe adult brain injury patients"],"prefix":"10.1186","volume":"28","author":[{"given":"Edith Elianna","family":"Rodriguez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Zaccarelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elda Diletta","family":"Sterchele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio Silvio","family":"Taccone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,4,1]]},"reference":[{"issue":"8","key":"4893_CR1","doi-asserted-by":"publisher","first-page":"982","DOI":"10.1001\/jamaneurol.2021.2043","volume":"78","author":"MA McCrea","year":"2021","unstructured":"McCrea MA, Giacino JT, Barber J, Temkin NR, Nelson LD, Levin HS, et al. 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