Real-time mmHg reading derived from EVD or Bolt monitoring systems.
Critical threshold: 22 mmHg (BTF 4th Ed).
Pressure Matrix Scan
Integrate absolute ICP values into standardized neuro-critical care protocols to prevent secondary brain injury and herniation.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Management of severe TBI in the intensive care unit.
Spontaneous ICH or SAH with monitored intracranial hypertension.
Identifying thresholds for medical escalation (Tier 1/2/3 therapies).
Decision support for surgical decompression (Craniectomy).
Section 2
Formula & Logic
Threshold Tiers
ICP (mmHg)
Category
Recommended Action
< 15
Safe
Routine monitoring (Tier 0).
15 – 22
Borderline
Optimize physiology (Positioning, Sedation).
> 22
Hypertension
Escalate to Tier 1/2 (Osmolars, EVD drain).
> 30
Critical
Aggressive Tier 3 (Surgery, Barbiturates).
Section 3
Pearls/Pitfalls
22 is the New 20
The Brain Trauma Foundation (BTF) 4th Edition revised the intervention threshold to 22 mmHg (up from 20 mmHg). This adjustment was based on evidence showing that over-treatment of borderline hypertension (20–22) often led to more systemic complications (e.g., ARDS) without improving neurological outcomes.
Section 4
Evidence Appraisal
Primary Reference
Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition
