This study is of great importance, especially, as ICP-monitoring is an invasive technique and holds some risks for the patient. This study is another great example of how important high-quality large-scale studies with negative results are. However, as the authors clearly state, the value of knowing the precise intracranial pressure is not being challenged, nor is the value of aggressively treating severe traumatic brain injury being questioned. Management guided by clinical neurologic examination and serial brain CT is still the cornerstone of treatment for severe traumatic brain injury. Rather their data suggest that a reassessment of the role of manipulating strictly monitored intracranial pressure as part of multimodality monitoring and targeted treatment of severe traumatic brain injury is in order. Besides these data, important preliminary data also come from qEEG monitoring in these patients...

I agree with Dr. Sutter. ICP monitoring has always given a limited amount of information since it only measures the assumed global intracranial pressure. Through some of the studies using the Lycox tissue oxygenation monitoring and intracerebral temperature the actual pathology from traumatic brain injury may be more localized and/or regionalized. Hopefully with improvement in our technology and understanding of using magnetic resonance spectroscopy. Clearly a thorough clincal examination is the most important aspect in managing head injured patients. The serial CT exams for these patients as well as continuous EEG monitoring (especially those who are medicinally induced in a coma via pentobarbital monitoring for burst suppression) are those technoligal tools that can be readily used. The importance of reporting high quality studies with negative results is paramount especially when it involves patient care. Any study that is a quality study should be reported and published regardless of the actual results!!