Aspects on the cerebral perfusion pressure during therapy of a traumatic head injury
- 1 June 1997
- journal article
- Published by Wiley in Acta Anaesthesiologica Scandinavica
- Vol. 41 (S110), 36-40
- https://doi.org/10.1111/j.1399-6576.1997.tb05493.x
Abstract
An actively raised cerebral perfusion pressure by vasopressors is nowadays often advocated during therapy of a post traumatic brain oedema to improve oxygenation of the brain. In this paper we argue that the arterial pressure not uncritically can be raised as the subsequent increase in hydrostatic capillary pressure may favour transcapillary filtration if the blood-brain barrier is opened for solutes. Further, the use of vasoconstrictor drugs to increase the perfusion pressure may in fact impair oxygenation to the penumbra zones around brain contusions but also to other tissues of the body, like the intestinal mucosa and the kidney. An alternative therapeutical concept which both ensures an adequate oxygenation of the brain and controls the intracranial pressure (ICP) is given. In short, it implies active antistress and sedative treatment, adequate fluid therapy with blood and colloids to normal haemoglobine and albumin values, artificial ventilation to normal PaCO2 and PaO2, and this in combination with antihypertensive and catecholamine reducing treatment with alpha 2-agonist and beta 1-antagonist.Keywords
This publication has 13 references indexed in Scilit:
- Cerebral perfusion pressure: management protocol and clinical resultsJournal of Neurosurgery, 1995
- Effects of arterial and venous pressure alterations on transcapillary fluid exchange during raised tissue pressureIntensive Care Medicine, 1994
- A new therapy of post-trauma brain oedema based on haemodynamic principles for brain volume regulationIntensive Care Medicine, 1994
- THE ROLE OF SECONDARY BRAIN INJURY IN DETERMINING OUTCOME FROM SEVERE HEAD INJURYJournal Of Trauma-Injury Infection and Critical Care, 1993
- Early and Late Systemic Hypotension as a Frequent and Fundamental Source of Cerebral Ischemia Following Severe Brain Injury in the Traumatic Coma Data BankPublished by Springer Science and Business Media LLC ,1993
- Head injuryCritical Care Medicine, 1990
- Cerebral Edema and the Blood-Brain BarrierPublished by Springer Science and Business Media LLC ,1989
- Mechanisms and implications of hypoalbuminemia in head-injured patientsJournal of Neurosurgery, 1988
- REDUCTION OF STRESS/ CATECHOLAMINE-INDUCED CARDIAC NECROSIS BY BETA1-SELECTIVE BLOCKADEThe Lancet, 1987
- HEAD INJURY AND BRAIN ISCHAEMIA - IMPLICATIONS FOR THERAPYBritish Journal of Anaesthesia, 1985