The Monroe-Kellie doctrine guides management of raised intracranial pressure (ICP) after severe traumatic brain injury. Which ICP threshold and cerebral perfusion pressure (CPP) target are recommended by Brain Trauma Foundation (BTF) 2016 guidelines?

• A ICP <15 mmHg; CPP >70 mmHg
• B ICP <25 mmHg; CPP >50 mmHg
• C ICP <20 mmHg; CPP 60–70 mmHg ✓
• D ICP <10 mmHg; CPP >80 mmHg

Explanation

BTF 4th edition (2016) guidelines recommend treating ICP when it exceeds 22 mmHg (updated from earlier threshold of 20 mmHg) and targeting CPP of 60–70 mmHg (CPP = MAP − ICP). CPP below 50 mmHg is associated with ischemia, while aggressive MAP augmentation to target CPP >70 mmHg increases risk of ARDS. Current management includes osmotic therapy (hypertonic saline preferred over mannitol in many protocols), head elevation 30°, controlled normocapnia, sedation/analgesia, and neuromuscular blockade before considering decompressive craniectomy. The DECRA and RESCUEicp trials inform decompressive craniectomy thresholds.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.