Chesnut R, Aguilera S, Buki A, et al. - With the help of a consensus working group including 42 experienced and actively practicing severe traumatic brain injury (sTBI) opinion leaders from six continents, researchers intended to establish a modern sTBI protocol for adult patients with both intracranial pressure (ICP) and brain oxygen monitors in place. Three different treatment protocols were built, each with three tiers whereby higher tiers involve therapies with higher risk. The management of ICP rise in the setting of normal brain oxygenation was addressed in one protocol, and the second protocol addressed management of brain hypoxia with normal ICP. The third one addressed the situation involving the presence of both intracranial hypertension and brain hypoxia. While designing the different algorithms, issues related to blood transfusion and ventilator management were taken into account. Although these protocols are meant to help clinicians in the management of patients with both ICP and brain oxygen monitors, they do not indicate either a standard-of-care or a proxy for careful individualized management. Experts recommended using these protocols together with recommendations for basic care, management of critical neuroworsening and weaning treatment lately published in conjunction with the Seattle International Brain Injury Consensus Conference.