Outcome research relating to the management of CO and CBF in high-risk patients or during high-risk surgeries is needed. Frequent causes are intracranial mass lesions, disorders of CSF circulation, or more diffuse pathological processes. Several detectors can be placed over each hemisphere and a certain amount of information on regional perfusion can be acquired although without precise anatomical correlation.

CPP represents the pressure gradient across the cerebral vascular bed and is used as a therapeutic target for brain-injured patients in many intensive care units and is recommended by the Brain Trauma Foundation's, evidence based guideline.1. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. L. A. Steiner, P. J. D. Andrews, Monitoring the injured brain: ICP and CBF, BJA: British Journal of Anaesthesia, Volume 97, Issue 1, July 2006, Pages 26–38, https://doi.org/10.1093/bja/ael110. The first study,85 a randomized trial, was designed to answer the question, whether a CBF-targeted protocol, using a higher arterial blood pressure and optimized volume management to augment CBF, without targeting a specific range of CBF and or SjO2⁠, was superior to a conventional ICP-based strategy. The result of this study was corroborated in a separate study that showed the clinical reversal of the ischemic symptoms by dobutamine infusion combined with hypervolemic preloading in 78% of symptomatic patients.57  Intraaortic balloon pump counterpulsation has also been tested in this patient population. Brain inflammation is also caused by other issues, such as spinal cord swelling, and viral or bacterial infection. When it is not possible to insert an ICP monitoring device, for example because of severe coagulopathy, it is possible to estimate ICP from a transcranial Doppler examination with an absolute accuracy in the range ±10–15 mm Hg in most cases (Table 1).2,31 Techniques using tympanic membrane displacement to measure ICP have been unsatisfactory so far90 but, ultrasound wave transmission has shown some promise. Continuous monitoring of autoregulation is also possible using methods that calculate an index of autoregulation34 based on the response of flow velocity to slow spontaneous changes in CPP. A probe is inserted through a burr hole and placed on a cortical region of interest. If pressure reactivity is impaired, CBV will increase passively with increasing MAP, and ICP will increase.

Current management strategies for acute brain injury patients encompass the principle of physiological stability. The tip of the catheter must lie in the jugular bulb or at or above the level of the body of the 2nd cervical vertebra (C2).

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