Current concepts of optimal cerebral perfusion pressure in traumatic brain injury

Journal of Anaesthesiology Clinical Pharmacology

Volumn 30, Issue 3, 2014, Pages 318-327

  Prabhakar, Hemanshu ^a   Sandhu, Kavita ^b   Bhagat, Hemant ^c   Durga, Padmaja ^d   Chawla, Rajiv ^e  

^a ALL INDIA INSTITUTE OF MEDICAL SCIENCES   (India)

^b Department of Neuroanaesthesiology and Critical Care Max Superspeciality Hospital   (India)

^c POSTGRADUATE INSTITUTE OF MEDICAL EDUCATION AND RESEARCH   (India)

^d NIZAM'S INSTITUTE OF MEDICAL SCIENCES   (India)

^e G B PANT HOSPITAL   (India)

Author keywords

Cerebral perfusion pressure; Evidence; management protocols; Neuromonitoring; Optimal; Traumatic brain injury

Indexed keywords

EID: 84905821707     PISSN: 09709185     EISSN: 22312730     Source Type: Journal    
DOI: 10.4103/0970-9185.137260     Document Type: Review

References (101)

1. Young JS, Blow O, Turrentine F, Claridge JA, Schulman A: Is there an upper limit of intracranial pressure in patients with severe head injury if cerebral perfusion pressure is maintained? Neurosurg Focus 2003;15:E2.
2. Bratton SL, Chestnut RM, Ghajar J, et al. Guidelines for the management of severe traumatic brain injury. XV. Steroids. J Neurotrauma 2007;24 Suppl 1:S91-5.
3. Jones SC, Radinsky CR, Furlan AJ, et al. Variability in the magnitude of the cerebral blood flow response and the shape of the cerebral blood flow-pressure autoregulation curve during hypotension in normal rats [corrected]. Anesthesiology 2002;97:488-96.
4. Sanders RD, Degos V, Young WL. Cerebral perfusion under pressure: Is the autoregulatory 'plateau' a level playing field for all? Anaesthesia 2011;66:968-72.
5. Czosnyka M, Smielewski P, Piechnik S, Steiner LA, Pickard JD. Cerebral autoregulation following head injury. J Neurosurg 2001;95:756-63.
6. Rosner MJ, Rosner SD, Johnson AH. Cerebral perfusion pressure: Management protocol and clinical results. J Neurosurg 1995;83:949-62.
7. Asgeirsson B, Grande PO, Nordstrom CH. A new therapy of posttrauma brain oedema based on haemodynamic principles for brain volume regulation. Intensive Care Med 1994;20:260-7.
8. Stein SC, Georgoff P, Meghan S, Mirza KL, El Falaky OM. Relationship of aggressive monitoring and treatment to improved outcomes in severe traumatic brain injury. J Neurosurg 2010;112:1105-12.
9. Patel HC, Bouamra O, Woodford M, King AT, Yates DW, Lecky FE. Trends in head injury outcome from 1989 to 2003 and the effect of neurosurgical care: An observational study. Lancet 2005;366: 1538-44.
10. Marmarou A, Saad A, Aygok G, Rigsbee M. Contribution of raised ICP and hypotension to CPP reduction in severe brain injury: Correlation to outcome. Acta Neurochir Suppl 2005;95:277-80.
11. Narayan RK, Kishore PR, Becker DP et al. Intracranial pressure: To monitor or not to monitor? A review of our experience with severe head injury. J Neurosurg 1982;56:650-9.
12. Bratton SL, Chestnut RM, Ghajar J, et al. Guidelines for the management of severe traumatic brain injury. VIII. Intracranial pressure thresholds. J Neurotrauma 2007;24 Suppl 1:S55-8.
13. Aucoin PJ, Kotilainen HR, Gantz NM, Davidson R, Kellogg P, Stone B. Intracranial pressure monitors. Epidemiologic study of risk factors and infections. Am J Med 1986;80:369-76.
14. Exo J, Kochanek PM, Adelson PD, et al. Intracranial pressuremonitoring systems in children with traumatic brain injury: Combining therapeutic and diagnostic tools. Pediatr Crit Care Med 2010.
15. Nordstrom CH. Physiological and biochemical principles underlying volume-targeted therapy - the "Lund concept". Neurocrit Care 2005;2:83-95.
16. Bouma GJ, Muizelaar JP. Relationship between cardiac output and cerebral blood flow in patients with intact and with impaired autoregulation. J Neurosurg 1990;73:368-74.
17. Bouma GJ, Muizelaar JP, Bandoh K, Marmarou A. Blood pressure and intracranial pressure-volume dynamics in severe head injury: Relationship with cerebral blood flow. J Neurosurg 1992;77:15-9.
18. Kiening KL, Hartl R, Unterberg AW, Schneider GH, Bardt T, Lanksch WR. Brain tissue pO2-monitoring in comatose patients: Implications for therapy. Neurol Res 1997;19:233-40.
19. Robertson CS, Valadka AB, Hannay HJ, et al. Prevention of secondary ischemic insults after severe head injury. Crit Care Med 1999;27:2086-95.
20. Nordstrom CH. Assessment of critical thresholds for cerebral perfusion pressure by performing bedside monitoring of cerebral energy metabolism. Neurosurg Focus 2003;15:E5.
21. Bratton SL, Chestnut RM, Ghajar J, et al. Guidelines for the management of severe traumatic brain injury. IX. Cerebral perfusion thresholds. J Neurotrauma 2007;24 Suppl 1:S59-64.
22. Rosner MJ, Daughton S. Cerebral perfusion pressure management in head injury. J Trauma 1990;30:933-40;discussion 40-1.
23. Contant CF, Valadka AB, Gopinath SP, Hannay HJ, Robertson CS. Adult respiratory distress syndrome: A complication of induced hypertension after severe head injury. J Neurosurg 2001;95:560-8.
24. Clifton GL, Miller ER, Choi SC, Levin HS. Fluid thresholds and outcome from severe brain injury. Crit Care Med 2002;30:739-45.
25. Bullock R, Chesnut RM, Clifton G, et al. Guidelines for the management of severe head injury. Brain Trauma Foundation. Eur J Emerg Med 1996;3:109-27.
26. Pietropaoli JA, Rogers FB, Shackford SR, Wald SL, Schmoker JD, Zhuang J. The deleterious effects of intraoperative hypotension on outcome in patients with severe head injuries. J Trauma 1992;33:403-7.
27. Howells T, Elf K, Jones PA, et al. Pressure reactivity as a guide in the treatment of cerebral perfusion pressure in patients with brain trauma. J Neurosurg 2005;102:311-7.
28. Sahuquillo J, Poca MA, Arribas M, Garnacho A, Rubio E. Interhemispheric supratentorial intracranial pressure gradients in head-injured patients: Are they clinically important? J Neurosurg 1999;90:16-26.
29. Bulger EM, Nathens AB, Rivara FP, Moore M, MacKenzie EJ, Jurkovich GJ. Management of severe head injury: Institutional variations in care and effect on outcome. Crit Care Med 2002;30:1870-6.
30. Chesnut RM, Temkin N, Carney N, et al. A trial of intracranialpressure monitoring in traumatic brain injury. N Engl J Med 2012;367:2471-81.
31. Cremer OL, van Dijk GW, van Wensen E, et al. Effect of intracranial pressure monitoring and targeted intensive care on functional outcome after severe head injury. Crit Care Med 2005;33:2207-13.
32. Carrera E, Kim DJ, Castellani G, et al. What shapes pulse amplitude of intracranial pressure? J Neurotrauma 2010;27:317-24.
33. Hu X, Xu P, Asgari S, Vespa P, Bergsneider M. Forecasting ICP elevation based on prescient changes of intracranial pressure waveform morphology. IEEE Trans Biomed Eng 2010;57:1070-8.
34. Hu X, Glenn T, Scalzo F, et al. Intracranial pressure pulse morphological features improved detection of decreased cerebral blood flow. Physiol Meas 2010;31:679-95.
35. Asgari S, Bergsneider M, Hamilton R, Vespa P, Hu X. Consistent Changes in Intracranial Pressure Waveform Morphology Induced by Acute Hypercapnic Cerebral Vasodilatation. Neurocrit Care 2010.
36. Brady KM, Shaffner DH, Lee JK, et al. Continuous monitoring of cerebrovascular pressure reactivity after traumatic brain injury in children. Pediatrics 2009;124:e1205-12.
37. Czosnyka M, Brady K, Reinhard M, Smielewski P, Steiner LA. Monitoring of cerebrovascular autoregulation: Facts, myths, and missing links. Neurocrit Care 2009;10:373-86.
38. Steiner LA, Czosnyka M, Piechnik SK, et al. Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury. Crit Care Med 2002;30:733-8.
39. Lavinio A, Rasulo FA, De Peri E, Czosnyka M, Latronico N. The relationship between the intracranial pressure-volume index and cerebral autoregulation. Intensive Care Med 2009;35:546-9.
40. Czosnyka M, Smielewski P, Timofeev I, et al. Intracranial pressure: More than a number. Neurosurg Focus 2007;22:E10.
41. Zweckberger K, Sakowitz OW, Unterberg AW, Kiening KL. [Intracranial pressure-volume relationship. Physiology and pathophysiology]. Anaesthesist 2009;58:392-7.
42. Abdullah J, Zamzuri I, Awang S, et al. Preliminary report on spiegelberg pre and post-operative monitoring of severe headinjured patients who received decompressive craniectomy. Acta Neurochir Suppl 2005;95:311-4.
43. Piper I, Dunn L, Contant C, et al. Multi-centre assessment of the Spiegelberg compliance monitor: Preliminary results. Acta Neurochir Suppl 2000;76:491-4.
44. Cruz J. The first decade of continuous monitoring of jugular bulb oxyhemoglobinsaturation: Management strategies and clinical outcome. Crit Care Med 1998;26:344-51.
45. Lam JM, Chan MS, Poon WS. Cerebral venous oxygen saturation monitoring: Is dominant jugular bulb cannulation good enough? Br J Neurosurg 1996;10:357-64.
46. Robertson CS, Narayan RK, Gokaslan ZL, et al. Cerebral arteriovenous oxygen difference as an estimate of cerebral blood flow in comatose patients. J Neurosurg 1989;70:222-30.
47. Murr R, Schurer L. Correlation of jugular venous oxygen saturation to spontaneous fluctuations of cerebral perfusion pressure in patients with severe head injury. Neurol Res 1995;17: 329-33.
48. Chieregato A, Marchi M, Zoppellari R, et al. Detection of early ischemia in severe head injury by means of arteriovenous lactate differences and jugular bulb oxygen saturation. Relationship with CPP, severity indexes and outcome. Preliminary analysis. Acta Neurochir Suppl 2002;81:289-93.
49. Gupta AK, Zygun DA, Johnston AJ, et al. Extracellular Brain pH and Outcome following Severe Traumatic Brain Injury. J Neurotrauma 2004;21:678-84.
50. Coles JP, Fryer TD, Smielewski P, et al. Incidence and mechanisms of cerebral ischemia in early clinical head injury. J Cereb Blood Flow Metab 2004;24:202-11.
51. Eriksson EA, Barletta JF, Figueroa BE, et al. Cerebral perfusion pressure and intracranial pressure are not surrogates for brain tissue oxygenation in traumatic brain injury. Clin Neurophysiol 2012;123:1255-60.
52. Nortje J, Gupta AK. The role of tissue oxygen monitoring in patients with acute brain injury. Br J Anaesth 2006;97:95-106.
53. Hoffman WE, Charbel FT, Edelman G, Hannigan K, Ausman JI. Brain tissue oxygen pressure, carbon dioxide pressure and pH during ischemia. Neurol Res 1996;18:54-6.
54. van Santbrink H, vd Brink WA, Steyerberg EW, Carmona Suazo JA, Avezaat CJ, Maas AI. Brain tissue oxygen response in severe traumatic brain injury. Acta Neurochir (Wien) 2003;145:429-38;discussion 38.
55. Vespa P. What is the optimal threshold for cerebral perfusion pressure following traumatic brain injury? Neurosurg Focus 2003;15:E4.
56. Jodicke A, Hubner F, Boker DK. Monitoring of brain tissue oxygenation during aneurysm surgery: Prediction of procedurerelated ischemic events. J Neurosurg 2003;98:515-23.
57. Rangel-Castilla L, Lara LR, Gopinath S, Swank PR, Valadka A, Robertson C. Cerebral hemodynamic effects of acute hyperoxia and hyperventilation after severe traumatic brain injury. J Neurotrauma 2010;27:1853-63.
58. Soehle M, Jaeger M, Meixensberger J. Online assessment of brain tissue oxygen autoregulation in traumatic brain injury and subarachnoid hemorrhage. Neurol Res 2003;25:411-7.
59. Manwaring ML, Durham CA, McNally MM, Agle SC, Parker FM, Stoner MC. Correlation of cerebral oximetry with internal carotid artery stump pressures in carotid endarterectomy. Vasc Endovascular Surg 2010;44:252-6.
60. Sahuquillo J, Amoros S, Santos A, et al. Does an increase in cerebral perfusion pressure always mean a better oxygenated brain? A study in head-injured patients. Acta Neurochir Suppl 2000;76:457-62.
61. Stiefel MF, Spiotta A, Gracias VH, et al. Reduced mortality rate in patients with severe traumatic brain injury treated with brain tissue oxygen monitoring. J Neurosurg 2005;103:805-11.
62. Adamides AA, Cooper DJ, Rosenfeldt FL, et al. Focal cerebral oxygenation and neurological outcome with or without brain tissue oxygen-guided therapy in patients with traumatic brain injury. Acta Neurochir (Wien) 2009;151:1399-409.
63. Spiotta AM, Stiefel MF, Gracias VH, et al. Brain tissue oxygendirected management and outcome in patients with severe traumatic brain injury. J Neurosurg 2010;113:571-80.
64. Narotam PK, Burjonrappa SC, Raynor SC, Rao M, Taylon C. Cerebral oxygenation in major pediatric trauma: Its relevance to trauma severity and outcome. J Pediatr Surg 2006;41:505-13.
65. Narotam PK, Morrison JF, Nathoo N. Brain tissue oxygen monitoring in traumatic brain injury and major trauma: Outcome analysis of a brain tissue oxygen-directed therapy. J Neurosurg 2009;111:672-82.
66. Martini RP, Deem S, Yanez ND, et al. Management guided by brain tissue oxygen monitoring and outcome following severe traumatic brain injury. J Neurosurg 2009;111:644-9.
67. Jaeger M, Dengl M, Meixensberger J, Schuhmann MU. Effects of cerebrovascular pressure reactivity-guided optimization of cerebral perfusion pressure on brain tissue oxygenation after traumatic brain injury. Crit Care Med 2010;38:1343-7.
68. Zauner A, Doppenberg EM, Woodward JJ, Choi SC, Young HF, Bullock R. Continuous monitoring of cerebral substrate delivery and clearance: Initial experience in 24 patients with severe acute brain injuries. Neurosurgery 1997;41:1082-91;discussion 91-3.
69. Zauner A, Doppenberg E, Woodward JJ, et al. Multiparametric continuous monitoring of brain metabolism and substrate delivery in neurosurgical patients. Neurol Res 1997;19:265-73.
70. Belli A, Sen J, Petzold A, Russo S, Kitchen N, Smith M. Metabolic failure precedes intracranial pressure rises in traumatic brain injury: A microdialysis study. Acta Neurochir (Wien) 2008;150:461-9;discussion 70.
71. Stahl N, Ungerstedt U, Nordstrom CH. Brain energy metabolism during controlled reduction of cerebral perfusion pressure in severe head injuries. Intensive Care Med 2001;27:1215-23.
72. Johnston AJ, Steiner LA, Chatfield DA, et al. Effect of cerebral perfusion pressure augmentation with dopamine and norepinephrine on global and focal brain oxygenation after traumatic brain injury. Intensive Care Med 2004;30:791-7.
73. Czosnyka M, Smielewski P, Piechnik S, et al. Continuous assessment of cerebral autoregulation - clinical verification of the method in head injured patients. Acta Neurochir Suppl 2000;76:483-4.
74. Voulgaris SG, Partheni M, Kaliora H, Haftouras N, Pessach IS, Polyzoidis KS. Early cerebral monitoring using the transcranial Doppler pulsatility index in patients with severe brain trauma. Med Sci Monit 2005;11:CR49-52.
75. Czosnyka M, Smielewski P, Kirkpatrick P, Piechnik S, Laing R, Pickard JD. Continuous monitoring of cerebrovascular pressurereactivity in head injury. Acta Neurochir Suppl 1998;71:74-7.
76. Jagersberg M, Schaller C, Bostrom J, Schatlo B, Kotowski M, Thees C. Simultaneous bedside assessment of global cerebral blood flow and effective cerebral perfusion pressure in patients with intracranial hypertension. Neurocrit Care 2010;12:225-33.
77. Reinhard M, Neunhoeffer F, Gerds TA, et al. Secondary decline of cerebral autoregulation is associated with worse outcome after intracerebral hemorrhage. Intensive Care Med 2011;36:264-71.
78. Thees C, Scholz M, Schaller MDC, et al. Relationship between intracranial pressure and critical closing pressure in patients with neurotrauma. Anesthesiology 2002;96:595-9.
79. Al-Rawi PG, Kirkpatrick PJ. Tissue oxygen index: Thresholds for cerebral ischemia using near-infrared spectroscopy. Stroke 2006;37:2720-5.
80. Zweifel C, Castellani G, Czosnyka M, et al. Noninvasive monitoring of cerebrovascular reactivity with near infrared spectroscopy in head-injured patients. J Neurotrauma 2010;27:1951-8.
81. Steiner LA, Pfister D, Strebel SP, Radolovich D, Smielewski P, Czosnyka M. Near-infrared spectroscopy can monitor dynamic cerebral autoregulation in adults. Neurocrit Care 2009;10:122-8.
82. Chan KH, Miller JD, Dearden NM, Andrews PJ, Midgley S. The effect of changes in cerebral perfusion pressure upon middle cerebral artery blood flow velocity and jugular bulb venous oxygen saturation after severe brain injury. J Neurosurg 1992;77:55-61.
83. Vespa P, Prins M, Ronne-Engstrom E, et al. Increase in extracellular glutamate caused by reduced cerebral perfusion pressure and seizures after human traumatic brain injury: A microdialysis study. J Neurosurg 1998;89:971-82.
84. Menzel M, Soukup J, Henze D, et al. Brain tissue oxygen monitoring for assessment of autoregulation: Preliminary results suggest a new hypothesis. J Neurosurg Anesthesiol 2003;15:33-41.
85. Bruzzone P, Dionigi R, Bellinzona G, Imberti R, Stocchetti N. Effects of cerebral perfusion pressure on brain tissue PO2 in patients with severe head injury. Acta Neurochir Suppl 1998;71:111-3.
86. Artru F, Jourdan C, Perret-Liaudet A, Charlot M, Mottolese C. Low brain tissue oxygen pressure: Incidence and corrective therapies. Neurol Res 1998;20 Suppl 1:S48-51.
87. Kiening KL, Unterberg AW, Bardt TF, Schneider GH, Lanksch WR. Monitoring of cerebral oxygenation in patients with severe head injuries: Brain tissue PO2 versus jugular vein oxygen saturation. J Neurosurg 1996;85:751-7.
88. Changaris DG, McGraw CP, Richardson JD, Garretson HD, Arpin EJ, Shields CB. Correlation of cerebral perfusion pressure and Glasgow Coma Scale to outcome. J Trauma 1987;27:1007-13.
89. McGraw CP. A cerebral perfusion pressure greater than 80 mmHg is more beneficial. In. Hoff JT, Betz AL (Editors). Intracranial Pressure VII. Berlin, Springer-Verlag, 1989, 839-841
90. Juul N, Morris GF, Marshall SB, Marshall LF. Intracranial hypertension and cerebral perfusion pressure: Influence on neurological deterioration and outcome in severe head injury. The Executive Committee of the International Selfotel Trial. J Neurosurg 2000;92:1-6.
91. Andrews PJ, Sleeman DH, Statham PF, et al. Predicting recovery in patients suffering from traumatic brain injury by using admission variables and physiological data: A comparison between decision tree analysis and logistic regression. J Neurosurg 2002;97:326-36.
92. Downard C, Hulka F, Mullins RJ, et al. Relationship of cerebral perfusion pressure and survival in pediatric brain-injured patients. J Trauma 2000;49:654-8;discussion 58-9.
93. Reinert M, Barth A, Rothen HU, Schaller B, Takala J, Seiler RW. Effects of cerebral perfusion pressure and increased fraction of inspired oxygen on brain tissue oxygen, lactate and glucose in patients with severe head injury. Acta Neurochir (Wien) 2003;145:341-9;discussion 49-50.
94. Catala-Temprano A, Claret Teruel G, Cambra Lasaosa FJ, Pons Odena M, Noguera Julian A, Palomeque Rico A. Intracranial pressure and cerebral perfusion pressure as risk factors in children with traumatic brain injuries. J Neurosurg 2007;106:463-6.
95. Mehta A, Kochanek PM, Tyler-Kabara E, et al. Relationship of intracranial pressure and cerebral perfusion pressure with outcome in young children after severe traumatic brain injury. Dev Neurosci 2010;32:413-9.
96. Figaji AA, Zwane E, Thompson C, et al. Brain tissue oxygen tension monitoring in pediatric severe traumatic brain injury. Part 1: Relationship with outcome. Childs Nerv Syst 2009;25:1325-33.
97. Brady KM, Lee JK, Kibler KK, et al. Continuous time-domain analysis of cerebrovascular autoregulation using near-infrared spectroscopy. Stroke 2007;38:2818-25.
98. Chan KH, Dearden NM, Miller JD, Andrews PJ, Midgley S. Multimodality monitoring as a guide to treatment of intracranial hypertension after severe brain injury. Neurosurgery 1993;32:547-52;discussion 52-3.
99. Globus MY, Busto R, Dietrich WD, Martinez E, Valdes I, Ginsberg MD. Effect of ischemia on the in vivo release of striatal dopamine, glutamate, and gamma-aminobutyric acid studied by intracerebral microdialysis. J Neurochem 1988;51:1455-64.
100. Vespa PM, McArthur D, O'Phelan K, et al. Persistently low extracellular glucose correlates with poor outcome 6 months after human traumatic brain injury despite a lack of increased lactate: A microdialysis study. J Cereb Blood Flow Metab 2003;23:865-77.
101. al-Rawi PG, Hutchinson PJ, Gupta AK, Piechnik SK, Pickard JD, Kirkpatrick PJ. Multiparameter brain tissue monitoring - correlation between parameters and identification of CPP thresholds. Zentralbl Neurochir 2000;61:74-9.