RESUMEN

BACKGROUND: In this article, we discuss the dramatic decline in the utilization of invasive cranial monitoring of patients with traumatic brain injury (TBI). CASE DESCRIPTION: A 52-year-old male presented with a severe TBI following a motor vehicle accident. The initial computed tomography scan showed a subdural hematoma, and the patient underwent a craniotomy. However, preoperatively, intraoperatively, and postoperatively, the critical care team never utilized invasive cranial monitoring. Therefore, when the patient expired several weeks later due to multiorgan failure, his death was in part attributed to the neurocritical care specialists' failure to employ invasive cranial monitoring techniques. CONCLUSION: Evidence-based and defensive medicine, cost containment, and a lack of leadership have contributed to neurocritical care specialists' increased failure to utilize invasive hemodynamic and neurological monitoring for TBI.