Intracranial pressure monitoring: headstone or a new head start. The BEST TRIP trial in perspective

Excerpt

Intracranial pressure (ICP) monitoring is considered the standard of care for severe traumatic brain injury (sTBI) and its use is suggested by guidelines [1]. The efficacy of treatment based on monitoring in improving outcome had not been rigorously assessed, however, until the recently published BEST TRIP study [2]. This was a multicenter, controlled trial in Bolivia and Ecuador in which 324 patients with sTBI were randomly assigned to one of two specific protocols: guideline-based management based on monitored ICP versus treatment based on imaging and clinical examination. The primary outcome was a composite of survival time, impaired consciousness, and functional status at 3 months and 6 months and neuropsychological status at 6 months. The trial found that care focused on maintaining monitored ICP at 20 mmHg or less was not superior to care based on imaging and clinical examination. A major concern of the authors was that misinterpretation of these results might lead to abandoning ICP monitoring in managing sTBI. …