Cerebral Perfusion Pressure Based Management of Traumatic Brain Injury
نویسنده
چکیده
Cerebral perfusion pressure (CPP) is the difference between mean arterial pressure (MAP) and intracranial pressure (ICP). Traditionally, management of traumatic brain injury (TBI) depended mainly on ICP control strategies. Based on the evidence that cerebral ischemia plays a major role in causing poor neurological outcome in traumatic brain injury (TBI) and cerebral blood flow autoregulation is shifted rightward in these patients, Rosner and colleagues suggested a treatment protocol that advocated maintaining a CPP higher than 70 mmHg, by controlling intracranial hypertension and increasing MAP by using hypervolemia and vasoactive agents, if required. Following the initial studies that showed better outcomes than other contemporary series, a number of studies tried to define the critical CPP in TBI. The threshold values suggested by these studies varied widely between 50 mmHg and higher than 70 mmHg. While there is no controversy about the adverse effects of low CPP, the major concerns in CPP-based therapy are a possible increase in brain oedema with a decrease in intracranial compliance and the systemic complications associated with the interventions used to achieve high CPP. There is no major evidence to suggest that high CPP increases ICP or decreases intracranial compliance. One major randomized trial comparing CPP-based and ICP-based strategies showed a major reduction in the incidence of cerebral ischemia with cerebral blood flow (CBF)-targeted therapy. But the same study also documented a five-fold increase in acute respiratory distress syndrome in patients managed by CPP-based strategy, and similar outcomes between the treatment groups. Following this, the brain trauma foundation (BTF) lowered the suggested CPP threshold to 60 mmHg from its original recommendation of 70 mmHg. Current research is focusing on the possibility of defining the optimal CPP for any given patient based on more objective measures of cerebral oxygenation, metabolism and CBF autoregulation. Critical thresholds of CPP in children remain ill-understood.
منابع مشابه
Cerebral perfusion pressure and brain ischaemia: can one size fit all?
Current recommendations regarding the management of patients after traumatic brain injury include reduction in brain tissue pressure (i.e. intracranial pressure) and maintenance of an adequate arterial pressure; these measures combined should result in cerebral perfusion pressure sufficient to achieve adequate oxygen delivery. After almost 20 years of observational studies comparing cerebral pe...
متن کاملTraumatic brain injury: intensive care management.
Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. The modern management of severe TBI has fallen into the domain of a multidisciplinary team led by neurointensivists, neuroanaesthetists, and neurosurgeons and is based on the avoidance of secondary injury, maintenance of cerebral perfusion pressure (CPP), and optimization of cerebral oxygenation. In this review,...
متن کاملICP/CPP therapy after traumatic brain injury
Objective: To evaluate the effects of a brain tissue oxygen (PtiO2) guided treatment in patients with traumatic brain injury. Methods: PtiO2 was monitored in 93 patients with severe traumatic brain injury. Forty patients admitted from 1993 to 1996 were treated with intracranial pressure/cerebral perfusion pressure (ICP/CPP) management alone (ICP < 20 mm Hg, CPP > 70 mm Hg). Fifty three patients...
متن کاملEarly cerebral perfusion pressure augmentation with phenylephrine after traumatic brain injury may be neuroprotective in a pediatric swine model.
OBJECTIVE Cerebral perfusion pressure<40 mm Hg following pediatric traumatic brain injury has been associated with increased mortality independent of age, and current guidelines recommend maintaining cerebral perfusion pressure between 40 mm Hg-60 mm Hg. Although adult traumatic brain injury studies have observed an increased risk of complications associated with targeting a cerebral perfusion ...
متن کاملManagement of traumatic brain injury patients
Traumatic brain injury (TBI) has been called the 'silent epidemic' of modern times, and is the leading cause of mortality and morbidity in children and young adults in both developed and developing nations worldwide. In recent years, the treatment of TBI has undergone a paradigm shift. The management of severe TBI is ideally based on protocol-based guidelines provided by the Brain Trauma Founda...
متن کاملDecompressive Hemicraniectomy, Intracerebral Hemorrhage, Malignant MCA Stroke, Traumatic Brain Injury, Aneurysmal Subarachnoid Hemorrhage, Intracranial Pressure, Herniation
6 ABSTRACT Increased intracranial pressure (ICP) secondary to severe brain injury is common. Increased ICP is commonly encountered in malignant middle cerebral artery ischemic stroke, traumatic brain injury, subarachnoid hemorrhage, and intracerebral hemorrhage. Multiple interventions – both medical and surgical – exist to manage increased ICP. Medical management is used as first-line therapy; ...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
دوره شماره
صفحات -
تاریخ انتشار 2018