Which treatments are safe and effective to reduce intracranial pressure following severe traumatic brain injury?

Perkins, Gavin D; Horner, Daniel; Naisbitt, Michael J

doi:10.1136/bmj-2020-061960

Cited by 1 publication

(2 citation statements)

References 24 publications

(35 reference statements)

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“…result in a marked and passive increase of ICP [15,21]. The MAP challenge can be used in situations of raised ICP to investigate the potential benefit of increased MAP to reduce ICP, when cerebral autoregulation is intact.…”

Section: Key Pointsmentioning

confidence: 99%

“…When cerebral autoregulation is intact, MAP increase will result in vasoconstriction and reduction of cerebral blood volume, as a result of which ICP will slightly decrease. Impaired cerebral autoregulation will result in a marked and passive increase of ICP [15,21]. The MAP challenge can be used in situations of raised ICP to investigate the potential benefit of increased MAP to reduce ICP, when cerebral autoregulation is intact.…”

Section: Estimating Cerebral Autoregulationmentioning

confidence: 99%

See 1 more Smart Citation

Beyond intracranial pressure: monitoring cerebral perfusion and autoregulation in severe traumatic brain injury

Dietvorst¹,

Depreitere²,

Meyfroidt

2023

Current Opinion in Critical Care

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Purpose of reviewSevere traumatic brain injury (TBI) remains the most prevalent neurological condition worldwide. Observational and interventional studies provide evidence to recommend monitoring of intracranial pressure (ICP) in all severe TBI patients. Existing guidelines focus on treating elevated ICP and optimizing cerebral perfusion pressure (CPP), according to fixed universal thresholds. However, both ICP and CPP, their target thresholds, and their interaction, need to be interpreted in a broader picture of cerebral autoregulation, the natural capacity to adjust cerebrovascular resistance to preserve cerebral blood flow in response to external stimuli.Recent findingsCerebral autoregulation is often impaired in TBI patients, and monitoring cerebral autoregulation might be useful to develop personalized therapy rather than treatment of one size fits all thresholds and guidelines based on unidimensional static relationships.SummaryToday, there is no gold standard available to estimate cerebral autoregulation. Cerebral autoregulation can be triggered by performing a mean arterial pressure (MAP) challenge, in which MAP is increased by 10% for 20 min. The response of ICP (increase or decrease) will estimate the status of cerebral autoregulation and can steer therapy mainly concerning optimizing patient-specific CPP. The role of cerebral metabolic changes and its relationship to cerebral autoregulation is still unclear and awaits further investigation.

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Section: Key Pointsmentioning

confidence: 99%

Section: Estimating Cerebral Autoregulationmentioning

confidence: 99%