Evidence map›Paper›PMID 41949746›Full record

Observational studyNeurocritical care2026

What Do We Do When the ICP Goes Up?

Randall M Chesnut, Nancy Temkin, Jason Barber, Christine Park, Robert H Bonow, BOOST II Investigators

Abstract readObservational Study
PubMed Publisher
In one paragraph

Observational study in Neurocritical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Randall M ChesnutDepartment of Neurological Surgery, University of Washington, 325 Ninth Ave, Mailstop 359766, Seattle, WA, 98104‑2499, USA. chesnutr@uw.edu.
Nancy TemkinDepartment of Neurological Surgery, University of Washington, 325 Ninth Ave, Mailstop 359766, Seattle, WA, 98104‑2499, USA.
Jason BarberDepartment of Neurological Surgery, University of Washington, 325 Ninth Ave, Mailstop 359766, Seattle, WA, 98104‑2499, USA.
Christine ParkDepartment of Neurological Surgery, University of Washington, 325 Ninth Ave, Mailstop 359766, Seattle, WA, 98104‑2499, USA.
Robert H BonowDepartment of Neurological Surgery, University of Washington, 325 Ninth Ave, Mailstop 359766, Seattle, WA, 98104‑2499, USA.
BOOST II Investigators

Funding

Phase II, randomized controlled trial of brain tissue oxygen monitoringR01NS061860 · NINDS · UT SOUTHWESTERN MEDICAL CENTER · PI BULLOCK, MALCOLM ROSS, CHESNUT, RANDALL M · 2009 to 2011
$2.4M
NINDS NIH HHS R01 NS061860
6 · The paper itself

Abstract

BACKGROUND/

objectiveWe sought to study which intracranial pressure (ICP)-lowering treatments are actually administered following the diagnosis of a clinical intracranial hypertension episode (CLICHÉ) during modern, routine care.

methodsWe performed a secondary analysis of data from patients with ICP only (normal or blinded partial pressure of brain tissue oxygen [PbtO

resultsOf the 119 randomized patients, 70 had 509 CLICHÉs that met forme fruste definition with complete datasets (71% of total CLICHÉs). Analgosedation adjustment and cerebrospinal fluid (CSF) drainage were the predominant treatments, used respectively in 72% and 33% of full CLICHÉs and within the first 15 min in 53% and 31%. In combination, they were the third most common intervention. Treatments often involved agent combinations (41% for full CLICHÉs; 46% within the first 15 min). Treatments that could be readily and discretionally administered by the bedside clinician represented 76% of treatments for full CLICHÉs and 69% for early interventions.

conclusionsAnalgosedation adjustment predominates as the treatment of choice for forme fruste CLICHÉs despite scarce literature support regarding mechanism, efficacy or influence on outcome. Frequent use of agent combinations confounds use of treatments (e.g. therapeutic intensity level) as a descriptive variable. Although details regarding clinical reasoning underlying intervention choices are lacking, it appears that intervention choice may be influenced by expediency outside of effectiveness. These findings accent the importance of understanding how treatment protocols are actually implemented. Investigation of the proper role of analgosedation adjustment and treatment combinations in ICP control is needed. Current management practices require targeted, physiology-based treatment guidance.

Indexed as

Brain Injuries, TraumaticCritical CareIntracranial HypertensionIntracranial PressureAdultHumansRandomized Controlled Trials as TopicClinical protocolsCritical careHypnotics and sedativesIntracranial pressureMonitoringTherapeuticsTraumatic brain injury

What OpenQuestion holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.