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Related Experiment Video

Updated: Apr 9, 2026

A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury

A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury

Published on: March 26, 2019

What Do We Do When the ICP Goes Up?

Randall M Chesnut^1,2,3,4, Nancy Temkin^5,6, Jason Barber⁵

¹Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Mailstop 359766, Seattle, WA, 98104‑2499, USA. chesnutr@uw.edu.

Neurocritical Care

|April 8, 2026

Summary

This summary is machine-generated.

Analgosedation adjustment and CSF drainage are common treatments for clinical intracranial hypertension episodes (CLICHÉs). Bedside clinicians often use these treatments, sometimes in combination, due to expediency rather than proven effectiveness.

Keywords:

Clinical protocols Critical care Hypnotics and sedatives Intracranial pressure Monitoring Therapeutics Traumatic brain injury

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Area of Science:

Neuroscience
Critical Care Medicine
Neurosurgery

Background:

Intracranial pressure (ICP) management is critical in severe traumatic brain injury.
Clinical intracranial hypertension episodes (CLICHÉs) require timely intervention.
Understanding current treatment practices for CLICHÉs is essential for optimizing patient care.

Purpose of the Study:

To investigate the specific ICP-lowering treatments administered during routine care for CLICHÉs.
To analyze the frequency, timing, and combinations of treatments used for forme fruste CLICHÉs.

Main Methods:

Secondary analysis of data from the BOOST II randomized trial.
Inclusion of patients with ICP monitoring and normal or blinded PbtO2.
Identification and cataloging of 'forme fruste' CLICHÉs (ICP > 20 mmHg for 5-60 min) and their treatments.

Main Results:

Analgosedation adjustment (72%) and CSF drainage (33%) were the most frequent treatments for forme fruste CLICHÉs.
These treatments were often administered within the first 15 minutes of a CLICHÉ.
Combinations of agents were common, complicating the assessment of individual treatment efficacy.

Conclusions:

Analgosedation adjustment is a prevalent treatment for forme fruste CLICHÉs, despite limited evidence on its mechanism and impact on outcomes.
Treatment choices may be influenced by ease of administration (expediency) rather than solely by effectiveness.
Further research is needed to clarify the role of analgosedation and treatment combinations in ICP management, emphasizing the need for physiology-based guidance.