Objective To investigate the effect of management with intracranial pressure (ICP) monitoring in acute severe traumatic brain injury. Methods Sixty-four patients with acute severe traumatic brain injury managed with ICP monitoring were selected, and the values of ICP, cerebral perfusion pressure (CPP), Glasgow coma scale (GCS) and Glasgow outcome scale (GOS) were recorded and analyzed. Results Fifty-two patients with surgical indication underwent hematoma removal and/or decompressive craniectomy with ICP monitoring, and the other 12 patients without surgical indication received ICP monitoring with ventricular catheter. There was no significant difference between the values of ICP and CPP 24 h after operation and those 72 h after operation (P>0.05). There were significant differences between the value of GCS on ICU admission and that 24 h after operation, between the value of GCS 24 h after operation and that 72 h after operation, and between the value of GCS 72 h after operation and that on ICU discharge (P<0.05 for all). The mean value of GOS was (4.13±0.72), and no death and vegetative state

occurred. Conclusion Management with ICP monitoring is effective in acute severe traumatic brain injury.