The field of neurocritical care and traumatic brain injury management is rapidly evolving. We are shifting from older (but not entirely outdated) monitoring techniques to novel diagnostic and therapeutic advances in critical care medicine. Managing intracranial pressure crises involves the careful tiptoeing of a line between maintaining brain circulation and yet reducing intracranial fluid volume. And many of our interventions rely on one simple mathematical construct: CPP = MAP - ICP [Cerebral perfusion pressure = Mean arterial pressure – Intracranial pressure] The importance of this formula cannot be understated. So we are spending 35 minutes today reviewing it, and discussing pearls and pitfalls of ICP monitoring and management. But believe me, it’s worth it. Produced by James E. Siegler and Jon Rosenberg. Music courtesy of Unheard Music Concepts, Rafael Archangel, Milton Arias, and Quincas Moreira. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES  Rosner MJ and Coley IB. Cerebral perfusion pressure, intracranial pressure, and head elevation. Journal of neurosurgery. 1986;65:636-41. Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W, Petroni G, Lujan S, Pridgeon J, Barber J, Machamer J, Chaddock K, Celix JM, Cherner M, Hendrix T and Global Neurotrauma Research G. A trial of intracranial-pressure monitoring in traumatic brain injury. The New England journal of medicine. 2012;367:2471-81. Kristiansson H, Nissborg E, Bartek J, Jr., Andresen M, Reinstrup P and Romner B. Measuring elevated intracranial pressure through noninvasive methods: a review of the literature. J Neurosurg Anesthesiol. 2013;25:372-85. Armstead WM. Cerebral Blood Flow Autoregulation and Dysautoregulation. Anesthesiol Clin. 2016;34:465-77. Oddo M, Crippa IA, Mehta S, Menon D, Payen JF, Taccone FS and Citerio G. Optimizing sedation in patients with acute brain injury. Crit Care. 2016;20:128. Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N, Rubiano AM, Shutter L, Tasker RC, Vavilala MS, Wilberger J, Wright DW and Ghajar J. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery. 2017;80:6-15. Okonkwo DO, Shutter LA, Moore C, Temkin NR, Puccio AM, Madden CJ, Andaluz N, Chesnut RM, Bullock MR, Grant GA, McGregor J, Weaver M, Jallo J, LeRoux PD, Moberg D, Barber J, Lazaridis C and Diaz-Arrastia RR. Brain Oxygen Optimization in Severe Traumatic Brain Injury Phase-II: A Phase II Randomized Trial. Critical care medicine. 2017;45:1907-1914. Harary M, Dolmans RGF and Gormley WB. Intracranial Pressure Monitoring-Review and Avenues for Development. Sensors (Basel). 2018;18. Koenig MA. Cerebral Edema and Elevated Intracranial Pressure. Continuum (Minneap Minn). 2018;24:1588-1602. Jahns FP, Miroz JP, Messerer M, Daniel RT, Taccone FS, Eckert P and Oddo M. Quantitative pupillometry for the monitoring of intracranial hypertension in patients with severe traumatic brain injury. Crit Care. 2019;23:155. Cook AM, Morgan Jones G, Hawryluk GWJ, Mailloux P, McLaughlin D, Papangelou A, Samuel S, Tokumaru S, Venkatasubramanian C, Zacko C, Zimmermann LL, Hirsch K and Shutter L. Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients. Neurocritical care. 2020;32:647-666. Robba C, Pozzebon S, Moro B, Vincent JL, Creteur J and Taccone FS. Multimodal non-invasive assessment of intracranial hypertension: an observational study. Crit Care. 2020;24:379.