Importance of keeping CPP > 60 mm Hg in TBI

[KMATTOX at aol.com]

In a message dated 8/5/2007 4:30:51 P.M. Central Daylight Time, ih7 at msn.com  
writes:

if the  ICP is increased, you need to keep the MAP 60 mm higher so the blood 
flows  forward through the brain


I would agree with that, but would plead that it is NOT crystalloid fluids  
which should be used to achieve that MAP.    Remember that most  of the studies 
of the past 30-40 yrs were in patients that had 3 liters (or  more) challenge 
of crystalloid prior to any surgeon, especially neurosurgeon,  seeing them.   
The ICP increase is a complex compartment syndrome and  much of our 
traditional urban legend therapy actually iatrogenicly contributed  to the spiraling 
increase in ICP.     
 
I am delighted to see the direction of the discussions on this web site,  and 
do believe that it is going to lead to a whole new wave of research.  
 
k



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