Cerebral hemodynamic responses to blood pressure manipulation in severely head-injured patients in the presence or absence of intracranial hypertension.

Anesthesia and Analgesia
O L CremerC J Kalkman

Abstract

The management of cerebral perfusion pressure (CPP) remains a controversial issue in the critical care of severely head-injured patients. Recently, it has been proposed that the state of cerebrovascular autoregulation should determine individual CPP targets. To find optimal perfusion pressure, we pharmacologically manipulated CPP in a range of 51 mm Hg (median; 25th-75th percentile, 48-53 mm Hg) to 108 mm Hg (102-112 mm Hg) on Days 0, 1, and 2 after severe head injury in 13 patients and studied the effects on intracranial pressure (ICP), autoregulation capacity, and brain tissue partial pressure of oxygen. Autoregulation was expressed as a static rate of regulation for 5-mm Hg CPP intervals based on middle cerebral artery flow velocity. When ICP was normal (26 occasions), there were no major changes in the measured variables when CPP was altered from a baseline level of 78 mm Hg (74-83 mm Hg), indicating that the brain was within autoregulation limits. Conversely, when intracranial hypertension was present (11 occasions), CPP reduction to less than 77 mm Hg (73-82 mm Hg) further increased ICP, decreased the static rate of regulation, and decreased brain tissue partial pressure of oxygen, whereas a CPP increase improved these va...Continue Reading

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Citations

Nov 26, 2009·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Anthony A Figaji
Nov 3, 2009·Journal of Neurosurgery. Pediatrics·Anthony A FigajiJonathan C Peter
Apr 22, 2006·ANZ Journal of Surgery·Alexios A AdamidesJeffrey V Rosenfeld
May 6, 2006·Annales Françaises D'anesthèsie Et De Rèanimation·M LeoneC Martin
Sep 24, 2004·Anesthesia and Analgesia·David S Warner, Cecil O Borel
Oct 26, 2005·The Surgeon : Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland·C D WinterJ V Rosenfeld
Dec 31, 2008·Journal of Intensive Care Medicine·Monica Trivedi, Jonathan P Coles
Sep 28, 2007·Anesthesia and Analgesia·Iain K Moppett, Jonathan G Hardman
Jun 25, 2005·Anesthesia and Analgesia·Carl-Henrik Nordström
Mar 15, 2006·Current Opinion in Anaesthesiology·François Girard
Mar 15, 2006·Current Opinion in Anaesthesiology·Ivan Timofeev, Arun Gupta
Dec 22, 2019·Brain Sciences·Magdalena Nowaczewska, Henryk Kaźmierczak
Jul 2, 2015·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·Philip M LewisWarwick Butt
Aug 4, 2020·Brain Injury : [BI]·Marcelo de-Lima-OliveiraEdson Bor-Seng-Shu
Jul 27, 2018·Neurology Research International·Marcelo de Lima OliveiraEdson Bor-Seng-Shu
Mar 11, 2021·Hypertension·Marcos Vinicius FernandesEduardo Colombari

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