Intracranial pressure management in patients with traumatic brain injury: an update.
OBJECTIVE
Intracranial pressure (ICP) monitoring and treatment is central in the management of traumatic brain injury. Despite 4 decades of clinical use, several aspects remain controversial, including the indications for ICP and treatment options.


RESULTS
Two major trials tested surgical decompression and mild hypothermia as treatments for high ICP. Both were rigorous, randomized, multicenter studies, with different designs. Decompression was tested for ICP refractory to conventional treatment, whereas hypothermia was offered as an alternative to conventional medical therapy. Decompression reduced mortality, but at the expense of more disability. The hypothermia trial was stopped because of a worse outcome in the treated arm. Indications for ICP monitoring have been reviewed and new international guidelines issued. New contributions published in 2016 have dealt with computerized analysis for predicting ICP crises; noninvasive or innovative methods for measuring ICP; reassessment of standard therapeutic interventions, such as hypertonic solutions and the level of intensity of ICP therapy.


CONCLUSIONS
Aggressive strategies for ICP control, like surgical decompression or hypothermia, carefully tested, have controversial effects on outcome. Several articles have made worthwhile contributions to important clinical issues, but with no real breakthroughs.
aNeuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico bDepartment of Pathophysiology and Transplants, University of Milan, Milan, Italy.
Nino
N
Stocchetti
Tommaso
T
Zoerle
Marco
M
Carbonara
D001930:Brain Injuries; D000070642:Brain Injuries, Traumatic / Q000628:therapy*; D019299:Decompression, Surgical; D006801:Humans; D007036:Hypothermia, Induced; D019586:Intracranial Hypertension; D007427:Intracranial Pressure