BTF 4th Ed. — Guidelines for the Management of Severe Traumatic Brain Injury, 4th Edition
Brain Trauma Foundation, 2016
ICP monitoring is recommended in salvageable patients with severe TBI and an abnormal CT. Treat ICP above approximately 22 mmHg, integrated with clinical/imaging findings. A large frontotemporoparietal decompressive craniectomy (rather than a small one) is recommended over a smaller craniectomy when the procedure is performed for refractory intracranial hypertension (2020 update).
Clinical Context & Relevant Topics (2)
Disease ReferenceMonro-Kellie doctrine, ICP waveforms (P2>P1, Lundberg A-waves), CPP targets (60–70 mmHg), herniation syndromes, and the 4-tier BTF management protocol.
Severe TBI neurocritical care: prevent hypoxemia/hypotension, treat intracranial hypertension, individualize ventilation/CPP, use evidence-based short antiseizure prophylaxis when chosen, and escalate surgery when indicated.