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REVIEW ARTICLE
Year : 2014  |  Volume : 30  |  Issue : 3  |  Page : 318-327

Current concepts of optimal cerebral perfusion pressure in traumatic brain injury


1 Department of Neuroanaesthesiology, Neurosciences Centre, All India Institute of Medical Sciences, PGIMER, Chandigarh, India
2 Department of Neuroanaesthesiology and Critical Care, Max Superspeciality Hospital, PGIMER, Chandigarh, India
3 Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
4 Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, India
5 Department of Anaesthesiology and Intensive Care, G B Pant Hospital, New Delhi, India

Correspondence Address:
Padmaja Durga
Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad - 500 089
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9185.137260

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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 (PbrO 2 ), 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.


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