1st May 2014 The BEST-TRIP trial.

Presented by Dr Shanelle Wijesuriya 

We will discuss a recent, important study on the management of traumatic brain injury. The paper is here.

This is an international multi-centre RCT which compared the use of ICP monitoring for TBI to a control arm of clinical parameters to guide the use of ICP lowering treatments. The measured outcomes were a series of functional and neuropsychological parameters.

As a couple of very simplistic thoughts about the wider discussion we may have, this study is important for two reasons, firstly it is the first time anyone has tried to develop level 1 evidence for the use of ICP monitoring in TBI. Secondly, and perhaps more importantly, it is a large RCT published in a major journal on a topic where, arguably, there is no equipoise. It usefully forces us to think about is whether we should be subjecting all of intensive care medicine to similar scrutiny and whether the model of how we look after patients, essentially making the numbers normal, is right for all diseases and whether we need different models for each disease and, moreover, whether we need different models within diseases, for example is all sepsis the same?

This study also raises interesting questions about whether RCTs are the right tool to examine treatments in intensive care medicine and whether other research methods, such as Comparative Effectiveness Research, should be employed more readily. As an aside , this is an interesting perspective on how we talk about evidence in medicine.

This paper has, unsurprisingly, been discussed widely:

An editorial in the BMJ (have a look at this!)

Editorial accompanying NEJM paper.

Editorial by the BEST-TRIP lead author this is nearly as essential reading as the first link.

Journal Club in CCForum

podcast from Royal North Shore, Sydney (the second half of the talk)

LITFL page on ICP