Neurological research · 2007
A synopsis of brain pressures: which? when? are they all useful?
СтатьяПоддержка исследования: вне правительства СШАОбзорНазвание и аннотация: Перевод в очереди
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Czosnyka Marek, Smielewski Peter, Lavinio Andrea, Czosnyka Zofia, Pickard John D
Аннотация
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.
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.