Assessment of the Lower Limit for Cerebral Perfusion Pressure in Severe Head Injuries by Bedside Monitoring of Regional Energy Metabolism

Abstract

The study results support the view that CPP may be reduced to 50 mmHg in patients with severe traumatic brain lesions, provided that the physiologic and pharmacologic principles of the Lund concept are recognized. In the individual patient, preservation of normal concentrations of energy metabolites within cerebral areas at risk can be guaranteed by intracerebral microdialysis and bedside biochemical analyses.

Severe traumatic brain injury in pediatric patients: treatment and outcome using an intracranial pressure targeted therapy—the Lund concept

“…The Lund concept accepts a CPP down to 40 mmHg in children [13]. This is in accordance with pediatric guidelines [28].…”

“…The physiological and biochemical effects of the treatment protocol have been evaluated in experimental and clinical studies since 1994 [10,11,12,13,14]. Decreased mortality in combination with increased favorable outcome has been reported in clinical studies [15,16,17].…”

Traumatic Brain Injury - Acute Care

“…Investigators studying the relationship between CPP on cerebral glucose metabolism have noted significant increases in the lactate/pyruvate ratio at CPPs less than 50mmHg which were confined to perilesional tissue. This work would seem to support the contention that susceptibility to ischemic insult is greater in a region of "tissue at risk" adjacent to contused brain (Nordstrom et al 2003). Data on hyperventilated patients have been conflicting, with some studies reporting no effect (Letarte et al 1999).…”

Cerebral Microdialysis: A Metabolic Sensor Inside the Closed Box

“…Specifically, intracranial pressure and cerebral perfusion pressure have both been reported to correlate with CMD values [8], and manipulation of these parameters is often firstline bedside response to pathological CMD values. In addition, there is a large body of literature suggesting that CMD monitoring is able to predict poor outcome after TBI and SAH.…”

“…In addition, there is a large body of literature suggesting that CMD monitoring is able to predict poor outcome after TBI and SAH. There is also some evidence that CMD may assist clinical decision-making, such as management of cerebral perfusion pressure [8], guidance of hyperventilation [9] and the appropriateness of extensive surgical procedures [10].…”