An algorithm for patients with intracranial pressure monitoring: filling the gap between evidence and practice

Excerpt

Raised intracranial pressure (ICP) and reduced cerebral perfusion pressure (CPP) are long-established and important causes of secondary brain injury that are associated with worsened clinical outcomes after traumatic brain injury (TBI) [1]. The monitoring and management of ICP/CPP has become the cornerstone of severe TBI management. The Brain Trauma Foundation (BTF) guidelines are considered the gold standard for the medical management of severe TBI [2], but previous versions were formulated using evidence now considered to be of ‘low quality’ and therefore unsuitable for guideline development. In the most recent, 2016, iteration of the BTF guidelines [2], a more rigorous approach was employed and low-quality studies excluded; between 1996 and 2016, 70% of recommendations were either discarded or downgraded [3]. While this approach improved the ‘evidence basis’ of the guidelines, it led to criticism that it limited their clinical relevance, in part because of the omission of (non-evidence-based) treatment algorithms [4]. …