Objective To explore the role of continuous pulse output (PICCO) monitoring in treatment of patients with traumatic acute diffuse brain swelling (PADBS). Methods Eighty-six PADBS patients, admitted to our hospital from January 2014 to October 2017, were routinely given brain invasive intracranial pressure (ICP) monitoring after admission. At the same time, the patients were given bone flap decompression and hematoma clearance according to the condition of the diseases. After surgery, according to the wishes of family members, patients were divided into two groups (n=43):patients from treatment group accepted PICCO monitoring on the basis of ICP monitoring, and the treatment plan was adjusted according to the monitoring results; and the treatment plan in patients from control group was adjusted according to traditional central venous pressure (CVP) monitoring results on basis of ICP monitoring. Results One week after operation, the ICP in the treatment group was (14.36±2.82) mmHg when the cerebral perfusion pressure (CPP) was controlled between 50 and 70 mmHg, which was significantly different from the ICP in the control group (18.58±2.25) mmHg (P<0.05). Two weeks after treatment, Glasgow Coma Scale (GCS) scores of the treatment group (10.87±1.72) were significantly higher than those of the control group (8.18±1.16, P<0.05). The incidences of posttraumatic cerebral infarction (PTCI) and neurogenic pulmonary edema (NPE) in the treatment group (11.6％, 18.6％) were significantly lower than those of the control group (25.6％, 34.9％, P<0.05); the recovery rate (76.7％) in the treatment group was significantly higher than that in the control group (60.5％, P<0.05); the mortality rate (9.3％) was significantly lower than that in the control group (18.6％, P<0.05). Conclusion On the basis of intraventricular ICP monitoring, combined PICCO monitoring can effectively control ICP, improve cerebral perfusion, reduce the incidence of PTCI and NPE, improve the prognosis, and reduce the mortality in PADBS patients.