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Neurol Res. 2007 Oct;29(7):672-9. doi: 10.1179/016164107X240053.

A synopsis of brain pressures: which? when? are they all useful?

Author information

1
Academic Neurosurgery Unit, Department of Neurosciences, University of Cambridge, Box 167, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK. MC141@medschl.cam.ac.uk

Abstract

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.

PMID:
18173906
DOI:
10.1179/016164107X240053
[Indexed for MEDLINE]

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