Document Detail


A synopsis of brain pressures: which? when? are they all useful?
MedLine Citation:
PMID:  18173906     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: In addition to intracranial pressure (ICP) and cerebral perfusion pressure (CPP), there are many more brain-related measures defined as 'pressures'. Cerebral intra-tissue pressure, critical closing pressure, 'optimal' CPP, non-invasive CPP (nCPP) and non-invasive ICP (nICP), interhemispherical pressure gradients are the modalities which currently attract more attention in the management of head injured patients.
METHODS: This review summarizes the most important points related to the 'brain pressures' applied in clinical practice, and it is based both on the literature and the authors' own experience.
RESULTS: While ICP and CPP monitoring remains the cornerstone of head injury management, derived pressures are gaining clinical significance. 'Optimization' of CPP provides a rational compromise between the 'Critical Closing Pressure-oriented protocol' and the 'Lund concept', and it allows individualized tailoring of cerebral hemodynamics. Non-invasive ICP and CPP are practical surrogates for invasive monitoring especially in the early stages of trauma management. CCP and pressure gradients are promising prognostication tools.
DISCUSSION: Most of the derived brain pressures cannot be assessed at the bedside without a dedicated computer tool. Some practical and theoretical aspects about the measurement, signal analysis, estimation process, accuracy and interpretation need further researching and refinement.
Authors:
Marek Czosnyka; Peter Smielewski; Andrea Lavinio; Zofia Czosnyka; John D Pickard
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Neurological research     Volume:  29     ISSN:  0161-6412     ISO Abbreviation:  Neurol. Res.     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2008-01-04     Completed Date:  2008-02-19     Revised Date:  2014-02-19    
Medline Journal Info:
Nlm Unique ID:  7905298     Medline TA:  Neurol Res     Country:  England    
Other Details:
Languages:  eng     Pagination:  672-9     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Blood Pressure*
Blood Pressure Determination / methods
Brain Injuries / complications,  physiopathology*
Cerebral Arteries / physiopathology
Cerebrovascular Circulation*
Homeostasis
Humans
Intracranial Hypertension / diagnosis*,  etiology,  physiopathology*
Intracranial Pressure*
Monitoring, Physiologic / methods
Grant Support
ID/Acronym/Agency:
G0001237//Medical Research Council

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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