Optimal cerebral perfusion pressure: are we ready for it?

Details

Serval ID
serval:BIB_4AB52C1F8D1B
Type
Article: article from journal or magazin.
Collection
Publications
Title
Optimal cerebral perfusion pressure: are we ready for it?
Journal
Neurological Research
Author(s)
Lazaridis C., Smielewski P., Steiner L.A., Brady K.M., Hutchinson P., Pickard J.D., Czosnyka M.
ISSN
1743-1328 (Electronic)
ISSN-L
0161-6412
Publication state
Published
Issued date
2013
Volume
35
Number
2
Pages
138-148
Language
english
Notes
Publication types: Journal ArticlePublication Status: ppublish
Abstract
OBJECTIVES: Cerebral perfusion pressure (CPP)-oriented therapy and the Lund concept lie on opposite ends of the CPP scale, in the management of head injury. Optimization of CPP by monitoring cerebral vascular pressure reactivity is an alternative approach that may reconcile these two divergent approaches, preventing both injurious hypotension and hypertension with an individualized CPP target.
METHODS: Indices describing cerebral vascular reactivity or cerebral blood flow autoregulation, derived from intracranial pressure, near-infrared spectroscopy, or transcranial Doppler are reviewed in this manuscript.
RESULTS: Indices of cerebrovascular reactivity and autoregulation typically converge to a U-shape curve when viewed as a function of CPP, with the best reactivity metrics indicating optimal CPP. In a retrospective study of prospectively collected data from head-injured patients, Steiner et al. demonstrated that a greater distance between averaged over total monitoring time-CPP and optimal CPP, correlated with unfavourable outcome. A recent study of 300 head-injured patients (2003-2009) showed that hypotension below optimal CPP was associated with greater mortality rate, while hypertension above optimal CPP was associated with an increase in severe disability.
DISCUSSION: Pilot studies indicating feasibility of autoregulation-oriented CPP optimization have been performed in adult and paediatric traumatic brain injury, aneurysmal subarachnoid haemorrhage, and in patients undergoing cardiothoracic surgery. It remains to be prospectively demonstrated whether optimal CPP management is able to improve outcome.
Pubmed
Web of science
Create date
12/04/2013 17:45
Last modification date
20/08/2019 13:58
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