title: Current concepts of optimal cerebral perfusion pressure in traumatic brain injury.
abstract: Traumatic brain injury (TBI) consists of varied pathophysiological consequences and alteration of intracranial dynamics, reduction of the cerebral blood flow and oxygenation. In the past decade more emphasis has been directed towards optimizing cerebral perfusion pressure (CPP) in patients who have suffered TBI. Injured brain may show signs of ischemia if CPP remains below 50 mmHg and raising the CPP above 60 mmHg may avoid cerebral oxygen desaturation. Though CPP above 70 mmHg is influential in achieving an improved patient outcome, maintenance of CPP higher than 70 mmHg was associated with greater risk of acute respiratory distress syndrome (ARDS). The target CPP has been laid within 50-70 mmHg. Cerebral blood flow and metabolism are heterogeneous after TBI and with regional temporal differences in the requirement for CPP. Brain monitoring techniques such as jugular venous oximetry, monitoring of brain tissue oxygen tension (PbrO2), and cerebral microdialysis provide complementary and specific information that permits the selection of the optimal CPP. This review highlights the rationale for use CPP directed therapies and neuromonitoring to identify optimal CPP of head injured patients. The article also reviews the evidence provided by various clinical trials regarding optimal CPP and their application in the management of head injured patients.
authors.affiliation: Department of Neuroanaesthesiology, Neurosciences Centre, All India Institute of Medical Sciences, PGIMER, Chandigarh, India.
authors.forename: Hemanshu
authors.initials: H
authors.lastname: Prabhakar
authors.affiliation: Department of Neuroanaesthesiology and Critical Care, Max Superspeciality Hospital, PGIMER, Chandigarh, India.
authors.forename: Kavita
authors.initials: K
authors.lastname: Sandhu
authors.affiliation: Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India.
authors.forename: Hemant
authors.initials: H
authors.lastname: Bhagat
authors.affiliation: Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, India.
authors.forename: Padmaja
authors.initials: P
authors.lastname: Durga
authors.affiliation: Department of Anaesthesiology and Intensive Care, G B Pant Hospital, New Delhi, India.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Chawla
keywords: Cerebral perfusion pressure; evidence; management protocols; neuromonitoring; optimal; traumatic brain injury