Importance of keeping CPP > 60 mm Hg in TBI

[IVAN HRONEK]

I look at it this way: the brain needs a lot of O2 and it is used to getting it at a perfusion pressure (MAP - ICP) of 60- 70 mm Hg: if the ICP is increased, you need to keep the MAP 60 mm higher so the blood flows forward through the brain. There often is a part of the brain tissue damaged beyond repair and then that just ischemic but reversibly impaired. You are trying to get that tissue "the ischemic penumbra" back by maintaining the CPP.
All other maneuvers you're describing are valid. Maintaining the CPP is a very important issue as you're dealing with an already injured brain and secondary injury is common, i.e. you can help or hurt the patient a lot.
I am enjoying this debate tremendously, please keep it polite and friendly, I know we are all tough & weathered trauma guys but still; thank you.
I 



> Date: Sun, 5 Aug 2007 11:33:14 -0700> From: medic0947969 at yahoo.com> To: trauma-list at trauma.org> Subject: Low Systolic BP "fad" and TBI> > > While reading the ongoing debate about ketamine and etomidate a comment was made about lower systolic pressures being a "fad." It was also commented on the effects this would have on an injured brain. > > I was understanding that the lower (70-80) systolic pressures was meant as a temporary therapy for resuscitaion, particularly for the purpose of reducing blood loss, prior to surgical control of bleeding. I assumed this was meant to be used during the out-of-hospital setting and in the Emergency Department, not as a long term recovery therapy in a surgical ICU or recovery. I also concluded that if a hernation of the brain was imminent or already the case, hypovolemia specifically due to loss, (opening in vascular container) would have to be addressed simultaneously if not prior. I also think that an emergency craniotomy would idealy reduce pressure enough to facilitate using a lower systolic pressure. In addition I was also under the impression that once bleeding was controlled that the theraputic end point for BP would be as close to normal as possible for the individual, not the 70-80 systolic. > > Please could somebody let me know if I am wrong or missing a key piece of information?> > I have read the 7th edition ATLS and in the early part of the book it mentions that it details common accepted practice not cutting edge medicine.> > Thanks,> Mike > > > ---------------------------------> Be a better Heartthrob. Get better relationship answers from someone who knows.> Yahoo! Answers - Check it out. > --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/