ICP and CPP management before and after 2007: impact on the association between dose of ICP and outcome.

Introduction In a recent paper, the intracranial pressure-time burden associated with worse outcome in traumatic brain injury (TBI) patients was visualised in a color-coded plot [1]. This color-coded plot illustrates the intuitive concept that episodes of higher intracranial pressure (ICP) can only be tolerated for shorter durations: the transition curve that delineates the duration and intensity of those ICP episodes associated with worse outcome is an approximately exponential decay curve. The study was done in a large prospective multicenter European cohort of patients, including patients from before and after 2007. In 2007, the guidelines on cerebral perfusion pressure (CPP) management in severe TBI have changed [2].