The Brain Trauma Foundation published its updated guidelines for the management of severe traumatic brain injury (sTBI) in fall 2016 on its website braintrauma.org, followed by an executive summary published in Neurosurgery in January 2017. The fourth edition of guidelines of sTBI is based on systematic review of Class 1 and Class 2/3 grade research studies, resulting in Level I, IIa/IIb and III recommendations.

The new guidelines include 28 evidence-based recommendations, of which 14 are new (e.g., cerebrospinal fluid drainage) or updated (e.g., hypothermia, nutrition and seizure prophylaxis) and 14 remain unchanged. The guideline chapters are treatment, monitoring and thresholds in the active management of sTBI. Summarized below are recommendations important for in-hospital care and related to risks for patients with severe TBI.

Interestingly, overall recommendations for anesthetic medications have not changed; it was reiterated that propofol at...

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