Evaluation of optimal cerebral perfusion pressure in severe traumatic brain injury

J. W. Lin; J. T. Tsai; C. M. Lin; L. M. Lee; K. S. Hung; S. J. Huang; S. H. Hsiao; W. Y. Chung; M. D. Tsai; C. C. Hsia; C. C. Hung; Wen Ta Chiu

doi:10.1007/978-3-211-78205-7_22

Evaluation of optimal cerebral perfusion pressure in severe traumatic brain injury

J. W. Lin, J. T. Tsai, C. M. Lin, L. M. Lee, K. S. Hung, S. J. Huang, S. H. Hsiao, W. Y. Chung, M. D. Tsai, C. C. Hsia, C. C. Hung, Wen Ta Chiu^*

^*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceeding › Chapter › peer-review

9 Scopus citations

Abstract

Traumatic brain injury (TBI) is a major cause of death and disability. In the 2000 guidelines, one of the suggestions for TBI treatment was to maintain cerebral perfusion pressure (CPP) < 70 mmHg. But in the 2003 guidelines, the suggestion was changed to < 60 mrnHg. There have been some discrepancies of opinions about this recommendation in recent publications. In this study, we retrospectively reviewed 305 severe TBI (STBI) patients with Glasgow Coma Scales (GCS) <8 between January 1, 2002 and March 31, 2003. The study group was stratified according to use or nonuse of intracranial pressure (ICP) monitoring, ICP levels, ages, and GCS levels in order to test the correlation between CCP and the prognosis. The patients <50-year-old, with higher GCS level, with ICP monitoring, and with ICP levels <20 mrnHg had lower mortality rates and better prognosis (GOS) (p<0.05 or 0.001). The patients in the GCS 3-5 subgroup had a significantly lower mortality and better prognosis if the CPP value was maintained higher than 70 mmHg (p < 0.05) The optimal CPP maintained ≤ 60 mmHg did not fit in all STBI patients. Our study concludes that it is critical to maintain CPP substantially higher in lower GCS level patients.

Original language	English
Title of host publication	Reconstructive Neurosurgery
Publisher	Springer-Verlag Wien
Pages	131-136
Number of pages	6
Edition	101
ISBN (Print)	9783211782040
DOIs	https://doi.org/10.1007/978-3-211-78205-7_22
State	Published - 2008
Externally published	Yes

Publication series

Name	Acta Neurochirurgica, Supplementum
Number	101
ISSN (Print)	0065-1419

Keywords

Glasgow coma scale (GCS)
Glasgow outcome scale (GOS)
Traumatic brain injury (TBI)
cerebral perfusion pressure (CPP)
intracranial pressure (ICP)

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10.1007/978-3-211-78205-7_22

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Lin, J. W., Tsai, J. T., Lin, C. M., Lee, L. M., Hung, K. S., Huang, S. J., Hsiao, S. H., Chung, W. Y., Tsai, M. D., Hsia, C. C., Hung, C. C., & Chiu, W. T. (2008). Evaluation of optimal cerebral perfusion pressure in severe traumatic brain injury. In Reconstructive Neurosurgery (101 ed., pp. 131-136). (Acta Neurochirurgica, Supplementum; No. 101). Springer-Verlag Wien. https://doi.org/10.1007/978-3-211-78205-7_22

@inbook{43d8fdf72057467e8e9baff927f19659,

title = "Evaluation of optimal cerebral perfusion pressure in severe traumatic brain injury",

abstract = "Traumatic brain injury (TBI) is a major cause of death and disability. In the 2000 guidelines, one of the suggestions for TBI treatment was to maintain cerebral perfusion pressure (CPP) < 70 mmHg. But in the 2003 guidelines, the suggestion was changed to < 60 mrnHg. There have been some discrepancies of opinions about this recommendation in recent publications. In this study, we retrospectively reviewed 305 severe TBI (STBI) patients with Glasgow Coma Scales (GCS) <8 between January 1, 2002 and March 31, 2003. The study group was stratified according to use or nonuse of intracranial pressure (ICP) monitoring, ICP levels, ages, and GCS levels in order to test the correlation between CCP and the prognosis. The patients <50-year-old, with higher GCS level, with ICP monitoring, and with ICP levels <20 mrnHg had lower mortality rates and better prognosis (GOS) (p<0.05 or 0.001). The patients in the GCS 3-5 subgroup had a significantly lower mortality and better prognosis if the CPP value was maintained higher than 70 mmHg (p < 0.05) The optimal CPP maintained ≤ 60 mmHg did not fit in all STBI patients. Our study concludes that it is critical to maintain CPP substantially higher in lower GCS level patients.",

keywords = "Glasgow coma scale (GCS), Glasgow outcome scale (GOS), Traumatic brain injury (TBI), cerebral perfusion pressure (CPP), intracranial pressure (ICP)",

author = "Lin, {J. W.} and Tsai, {J. T.} and Lin, {C. M.} and Lee, {L. M.} and Hung, {K. S.} and Huang, {S. J.} and Hsiao, {S. H.} and Chung, {W. Y.} and Tsai, {M. D.} and Hsia, {C. C.} and Hung, {C. C.} and Chiu, {Wen Ta}",

year = "2008",

doi = "10.1007/978-3-211-78205-7_22",

language = "英语",

isbn = "9783211782040",

series = "Acta Neurochirurgica, Supplementum",

publisher = "Springer-Verlag Wien",

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Lin, JW, Tsai, JT, Lin, CM, Lee, LM, Hung, KS, Huang, SJ, Hsiao, SH, Chung, WY, Tsai, MD, Hsia, CC, Hung, CC & Chiu, WT 2008, Evaluation of optimal cerebral perfusion pressure in severe traumatic brain injury. in Reconstructive Neurosurgery. 101 edn, Acta Neurochirurgica, Supplementum, no. 101, Springer-Verlag Wien, pp. 131-136. https://doi.org/10.1007/978-3-211-78205-7_22

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T1 - Evaluation of optimal cerebral perfusion pressure in severe traumatic brain injury

AU - Lin, J. W.

AU - Tsai, J. T.

AU - Lin, C. M.

AU - Lee, L. M.

AU - Hung, K. S.

AU - Huang, S. J.

AU - Hsiao, S. H.

AU - Chung, W. Y.

AU - Tsai, M. D.

AU - Hsia, C. C.

AU - Hung, C. C.

AU - Chiu, Wen Ta

PY - 2008

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N2 - Traumatic brain injury (TBI) is a major cause of death and disability. In the 2000 guidelines, one of the suggestions for TBI treatment was to maintain cerebral perfusion pressure (CPP) < 70 mmHg. But in the 2003 guidelines, the suggestion was changed to < 60 mrnHg. There have been some discrepancies of opinions about this recommendation in recent publications. In this study, we retrospectively reviewed 305 severe TBI (STBI) patients with Glasgow Coma Scales (GCS) <8 between January 1, 2002 and March 31, 2003. The study group was stratified according to use or nonuse of intracranial pressure (ICP) monitoring, ICP levels, ages, and GCS levels in order to test the correlation between CCP and the prognosis. The patients <50-year-old, with higher GCS level, with ICP monitoring, and with ICP levels <20 mrnHg had lower mortality rates and better prognosis (GOS) (p<0.05 or 0.001). The patients in the GCS 3-5 subgroup had a significantly lower mortality and better prognosis if the CPP value was maintained higher than 70 mmHg (p < 0.05) The optimal CPP maintained ≤ 60 mmHg did not fit in all STBI patients. Our study concludes that it is critical to maintain CPP substantially higher in lower GCS level patients.

AB - Traumatic brain injury (TBI) is a major cause of death and disability. In the 2000 guidelines, one of the suggestions for TBI treatment was to maintain cerebral perfusion pressure (CPP) < 70 mmHg. But in the 2003 guidelines, the suggestion was changed to < 60 mrnHg. There have been some discrepancies of opinions about this recommendation in recent publications. In this study, we retrospectively reviewed 305 severe TBI (STBI) patients with Glasgow Coma Scales (GCS) <8 between January 1, 2002 and March 31, 2003. The study group was stratified according to use or nonuse of intracranial pressure (ICP) monitoring, ICP levels, ages, and GCS levels in order to test the correlation between CCP and the prognosis. The patients <50-year-old, with higher GCS level, with ICP monitoring, and with ICP levels <20 mrnHg had lower mortality rates and better prognosis (GOS) (p<0.05 or 0.001). The patients in the GCS 3-5 subgroup had a significantly lower mortality and better prognosis if the CPP value was maintained higher than 70 mmHg (p < 0.05) The optimal CPP maintained ≤ 60 mmHg did not fit in all STBI patients. Our study concludes that it is critical to maintain CPP substantially higher in lower GCS level patients.

KW - Glasgow coma scale (GCS)

KW - Glasgow outcome scale (GOS)

KW - Traumatic brain injury (TBI)

KW - cerebral perfusion pressure (CPP)

KW - intracranial pressure (ICP)

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SN - 9783211782040

T3 - Acta Neurochirurgica, Supplementum

SP - 131

EP - 136

BT - Reconstructive Neurosurgery

PB - Springer-Verlag Wien

ER -

Evaluation of optimal cerebral perfusion pressure in severe traumatic brain injury

Abstract

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Keywords

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