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.
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: Jatinder S Minhas; William Rook; Ronney B Panerai; Ryan L Hoiland; Phil N Ainslie; Jonathan P Thompson; Amit K Mistri; Thompson G Robinson Journal: Br J Anaesth Date: 2019-12-06 Impact factor: 9.166
Authors: Caren Marzban; Paul R Illian; David Morison; Anne Moore; Michel Kliot; Marek Czosnyka; Pierre D Mourad Journal: J Neurosurg Anesthesiol Date: 2013-01 Impact factor: 3.956
Authors: Mypinder S Sekhon; Donald E Griesdale; Marek Czosnyka; Joseph Donnelly; Xia Liu; Marcel J Aries; Chiara Robba; Andrea Lavinio; David K Menon; Peter Smielewski; Arun K Gupta Journal: Neurocrit Care Date: 2015-10 Impact factor: 3.210
Authors: Shannon M Fernando; Alexandre Tran; Wei Cheng; Bram Rochwerg; Monica Taljaard; Kwadwo Kyeremanteng; Shane W English; Mypinder S Sekhon; Donald E G Griesdale; Dar Dowlatshahi; Victoria A McCredie; Eelco F M Wijdicks; Saleh A Almenawer; Kenji Inaba; Venkatakrishna Rajajee; Jeffrey J Perry Journal: BMJ Date: 2019-07-24