What is the optimal threshold for cerebral perfusion pressure following traumatic brain injury?
Intensive care of the patient with traumatic brain injury centers on control of intracranial pressure and cerebral perfusion pressure (CPP). The optimal CPP by definition delivers an adequate supply of blood and oxygen to meet the metabolic demands of brain tissue. A great deal of controversy exists regarding the optimal CPP value, with disparate studies providing conflicting evidence for the use of supraphysiological CPP values. No study that accurately assesses the efficacy of normal CPP compared with elevated CPP has been performed, but several studies demonstrate that a CPP threshold exists on an individual basis for patients with TBI. The use of brain monitors of cerebral metabolism and oxygen supply may assist the clinician in the selection of the optimal CPP for an individual patient.
Division of Neurosurgery, David Geffen School of Medicine at University of California at Los Angeles, USA. Pvespa@mednet.ucla.edu
Paul
P
Vespa
D001794:Blood Pressure; D001930:Brain Injuries / Q000503:physiopathology* / Q000628:therapy; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control; D002560:Cerebrovascular Circulation; D003128:Coma / Q000209:etiology / Q000517:prevention & control; D003422:Critical Care; D005440:Fluid Therapy / Q000009:adverse effects; D018698:Glutamic Acid / Q000378:metabolism; D006801:Humans; D002534:Hypoxia, Brain / Q000209:etiology / Q000517:prevention & control; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D019585:Intracranial Hypotension / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D007427:Intracranial Pressure; D017551:Microdialysis; D008991:Monitoring, Physiologic; D010092:Oximetry; D049268:Positron-Emission Tomography; D016032:Randomized Controlled Trials as Topic; D012128:Respiratory Distress Syndrome / Q000209:etiology; D017585:Ultrasonography, Doppler, Transcranial
D018698:Glutamic Acid