Cerebral Blood Flow and Metabolic Rates Monitoring in Brain Injury: Are Hemodynamic Manipulations an Effective Therapeutic Tool?

摘要

Intracranial pressure (ICP) control and cerebral perfusion pressure (CPP) management have been the mainstay of neurosurgical intensive care in severe head injury for the past decade. Recent studies, however, have challenged the validity of these parameters in terms of functional outcome. Daily recording of cerebral blood flow (CBF), ICP, CPP, arterial jugular difference for oxygen, glucose and lactate content were performed in 30 severely head-injured patients with a median Glasgow Coma Scale score of 6. CPP elevation did not correlate with improved CBF or cerebral metabolism. On the contrary, cerebral hyperemia could be noticed with CPP levels as low as 40 mmHg. There was no significant difference in CPP values in patients with good and poor outcome. CBF on admission and cerebral metabolic rate for glucose appeared as the best indicators of favorable outcome.