Intracranial pressure monitoring with and without brain tissue oxygen pressure monitoring for severe traumatic brain injury in France (OXY-TC): an open-label, randomised controlled superiority trial.
The Lancet. Neurology, 2023 · Multicenter randomized trial
What the trial found
51% ICP-only versus 52% combined; OR 1.0 (95% CI 0.6–1.7). Catheter dysfunction and catheter-related hemorrhage were more frequent with combined monitoring.
Clinical interpretation
Neutral superiority result does not prove equivalence; physiologic monitoring may inform selected care without established routine functional benefit.
Monro-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.