Viewpoint calls for multimodal assessment in severe traumatic brain injury

Management of severe traumatic brain injury has commonly used an intracranial pressure threshold of 22 mmHg, but the authors note that this recommendation is weak and based largely on physiological reasoning rather than randomized evidence. They cite a trial comparing pressure-guided care with a structured clinical and imaging-based protocol that found no difference in six-month functional outcomes.

The authors argue that intracranial pressure is an important predictor of mortality and disability but does not capture all secondary brain injury. They point to evidence from brain oxygen and metabolism monitoring, autoregulation, electrical activity, cerebrospinal fluid compliance, microcirculation and inflammatory biomarkers. They also emphasize that pressure burden over time and individual physiological context affect how a given reading should be interpreted.

The article is a viewpoint, not a new clinical study. It calls for integrated care strategies combining pressure with other physiological signals, while acknowledging that improved patient-centered outcomes from such strategies have not been demonstrated. The authors conclude that these approaches require testing in adequately powered trials; the article reports no funding or competing interests.