Acta Neurochirurgica

, Volume 159, Issue 12, pp 2279–2287 | Cite as

ICP management in patients suffering from traumatic brain injury: a systematic review of randomized controlled trials

  • Peter Abraham
  • Robert C. Rennert
  • Brandon C. Gabel
  • Jayson A. Sack
  • Navaz Karanjia
  • Peter Warnke
  • Clark C. Chen
Review Article - Brain Injury



Severe traumatic brain injury (sTBI) is a major cause of morbidity and mortality. Intracranial pressure (ICP) monitoring and management form the cornerstone of treatment paradigms for sTBI in developed countries. We examine the available randomized controlled trial (RCT) data on the impact of ICP management on clinical outcomes after sTBI.


A systematic review of the literature on ICP management following sTBI was performed to identify pertinent RCT articles.


We identified six RCT articles that examined whether ICP monitoring, decompressive craniectomy, or barbiturate coma improved clinical outcomes after sTBI. These studies support (1) the utility of ICP monitoring in the management of sTBI patients and (2) craniectomy and barbiturate coma as effective methods for the management of intracranial hypertension secondary to sTBI. However, despite adequate ICP control in sTBI patients, a significant proportion of surviving patients remain severely disabled.


If one sets the bar at the level of functional independence, then the RCT data raises questions pertaining to the utility of decompressive craniectomy and barbiturate coma in the setting of sTBI.


Traumatic brain injury Intracranial pressure Decompressive craniectomy 


Compliance with ethical standards

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethics approval/informed consent

This literature review did not involve direct human procedures. This article does not contain any studies with human participants performed by any of the authors. For this type of study formal consent is not required.

Supplementary material

701_2017_3363_MOESM1_ESM.docx (59 kb)
ESM 1 (DOCX 58 kb)


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Copyright information

© Springer-Verlag GmbH Austria 2017

Authors and Affiliations

  • Peter Abraham
    • 1
  • Robert C. Rennert
    • 1
  • Brandon C. Gabel
    • 1
  • Jayson A. Sack
    • 1
  • Navaz Karanjia
    • 1
  • Peter Warnke
    • 2
  • Clark C. Chen
    • 3
  1. 1.Department of NeurosurgeryUniversity of CaliforniaSan DiegoUSA
  2. 2.Section of NeurosurgeryUniversity of ChicagoChicagoUSA
  3. 3.Department of NeurosurgeryUniversity of Minnesota, UMMinneapolisUSA

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