Current management of traumatic intracranial hypertension: What you need to know

Intracranial hypertension (ICH) has long been recognized as a major challenge in the management of patients with severe traumatic brain injury. Although it has become widely accepted that patients with unremarkable brain computed tomography scans may not require invasive intracranial pressure (ICP) monitoring, the threshold for using such monitoring in other severe traumatic brain injury patients should be low. Intraparenchymal monitors and external ventricular drains are both effective monitoring techniques. No specific prophylactic interventions are available to prevent ICH. Instead, initial management focuses on maintaining physiological parameters in the normal range and intervening promptly when deviations occur. Management of elevated intracranial pressure proceeds along a series of interventions that begins with the least invasive and least complex measures and progressively escalates to those with greater scope and risk. However, the sequence of these steps is not rigorously defined, and considerable latitude may be exercised according to a specific patient's individual situation. Choosing the appropriate therapies for different patients requires the clinician to have a deep understanding of the pathophysiology of ICH. ( J Trauma Acute Care Surg . 2026;100: 837-849. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.).