Brain injury, traumatic cerebral perfusion pressure

Piper, I.R. Garrioch, M.A. Souter, M.J. Andrews, P.J.D. Thomson, D. Effects of diaspirin cross-linked haemoglobin on past-traumatic cerebral perfusion pressure and blood flow in a rodent model of diffuse brain injury. Brit. J. Anaesthes. 1998, 80, 639-643. 

Kahveci et al. (13) compared the cerebral protective effects of two known protective anesthetics, isoflurane and propofol, in combination with hypothermia (33-34°C) after traumatic brain injury (TBI). In that study, the authors found that propofol anesthesia plus hypothermia following TBI was better than the isoflurane-hypothermia combination because it reduced intracranial pressure and increased cerebral perfusion pressure under those conditions. 

A significant reduction of the ICP was seen, which was similar to the results of Marion and Shiozaki, who used hypothermic therapy in traumatic brain injuries (37,38). With an unaffected mean arterial blood pressure (MABP) and increased cerebral perfusion pressure (CPP), hypothermic therapy appeared to benefit stroke patients, as uncontrolled intracranial hypertension is the main cause of death in the first week after stroke. However, rewarming the patients consistently led to a secondary rise of ICP, which required additional ICP therapy with mannitol. In some cases it even exaggerated the initial ICP levels (Fig. 3). 

CCS, Glasgow Coma Scale BP, blood pressure HR, heart rate RR, respiratory rate CSF, cerebrospinal fluid TBI, traumatic brain injury ICP, intracranial pressure CPP, cerebral perfusion pressure ABC, arterial blood gas CBC, complete blood count Na, sodium K, potassium Cl, chloride Mg, magnesium Ca, calcium P, phosphorus CT, computed tomography. 

Brain Trauma Foimdation. Guidelines for the Management of Severe Traumatic Brain Injury Cerebral Perfusion Pressure. January 5, 2003 update, http /Avww2.braintrauma.org. 

Jaeger, M., Dengl, M., Meixensberger, J., et al., 2010. Effects of cerebrovascular pressure reactivity-guided optimization of cerebral perfusion pressure on brain tissue oxygenation after traumatic brain injury. Crit. Care Med. 38, 1343-1347. 

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