Impact of Early Optimization of Brain Oxygenation on Neurological Outcome After Severe Traumatic Brain Injury

Inclusion Criteria: * Age between 18 and 75 * Severe non- penetrating TBI (GCS score 3-8) with motor Glasgow score between 1 and 5 * Possible associated extracranial lesions, except tetraplegia * Initiation of cerebral monitoring within the first 16 hours since primary traumaticinjury * Indication of ICP monitoring on admission as part of the management * Indication of continuous sedation/analgesia for more than 48 hours * Under mechanical ventilation with stable conditions: PaO2//FiO2 over 150 and PaCO2 between 35 and 45 mmHg, mean arterial pressure over 70 mmHg * Written informed consent from legal surrogate, patient's relative or investigator decision * Affiliation to the French Social Security or affiliated to a social security system of EU member state, Norway, Lichtenstein, Iceland or Switzerland * French-speaking or English-speaking patient Exclusion Criteria: * Penetrating TBI * GCS 3 with bilateral fixed dilated pupils * Decompressive craniectomy and no repositioning of the bone flap after subdural hematoma evacuation surgery prior to enrolment * Contraindication of ICP and/or PbtO2 monitoring, i.e., hemostasis disorders and brain tissue infection * Persistent hemodynamic or respiratory instability despite treatments, i.e., mean arterial pressure \< 70 mmHg, PaO2/FiO2 \<150, PaCO2 \<30 mmHg or \>45 mmHg or lactate \>5 mmol/l if available. * Hypothermia \<34°C at randomization * Life expectancy \< 24 hours * Cardiac arrest at initial presentation * Tetraplegia * Neuropsychiatric co-morbidities that could interfere with 6 and 12-months assessment outcomes. * Consent refusal * Pregnancy * Participation in another therapeutic study with written consent * Inability to have a 6-months follow-up * Ischemic stroke after carotid arterial dissection * Incapacitated patients in accordance with article L 1121-5 to L1121-8 of the public health code.