Traditional modes of preventing brain cell death in traumatic brain injury (TBI) focus on the enhancement of cerebral perfusion pressure and control of intracranial pressure. Brain tissue oxygenation (PbtO2) monitoring systems are currently available to provide early detection of diminished cerebral oxygenation, and ultimately, ischemia. Research has demonstrated that early detection in PbtO2 is a more delicate measurement of cerebral blood flow and oxygenation. Monitoring PbtO2, in conjunction with cerebral perfusion pressure and intracranial pressure, has been shown to be a better guide to the prevention and treatment of secondary cerebral ischemia. This article reviews TBI, a PbtO2 monitor system description and indications for use, and the importance of nursing practice guidelines and education. With proper guidelines and education, this new technology can be used effectively by bedside clinicians and educators in adult and pediatric intensive care units.