Hemodynamic manipulation in the neuro-intensive care unit: Cerebral perfusion pressure therapy in head injury and hemodynamic augmentation for cerebral vasospasm

Michael N. Diringer, Yekaterina Axelrod

Research output: Contribution to journalReview articlepeer-review

25 Scopus citations

Abstract

PURPOSE OF REVIEW: The intent of this manuscript is to summarize the pathophysiologic basis for hemodynamic manipulation in subarachnoid hemorrhage and traumatic brain injury, highlight the most recent literature and present expert opinion on indications and use. RECENT FINDINGS: Hemodynamic augmentation with vasopressors and inotropes along with hypervolemia are the mainstay of treatment of vasospasm due to subarachnoid hemorrhage. Considerable variation continues to exist regarding fluid management and the use of vasopressors and inotropes. Blood pressure augmentation, volume expansion and cardiac contractility enhancement improve cerebral blood flow in ischemic areas, ameliorate vasospasm and improve clinical condition. In patients suffering from severe traumatic brain injury, while every attempt is made to control intracranial hypertension, cerebral perfusion-directed therapy with fluids and vasopressors is also used to keep cerebral perfusion pressure above 60-70 mmHg. Yet, recent observations suggest that posttraumatic mitochondrial dysfunction has been proposed as an alternative explanation for lower cerebral blood flow after acute trauma. SUMMARY: Hemodynamic manipulation is routinely used in the management of patients with acute vasospasm following subarachnoid hemorrhage and severe head injury. The rationale is to improve blood flow to the injured brain and prevent secondary ischemia.

Original languageEnglish
Pages (from-to)156-162
Number of pages7
JournalCurrent Opinion in Critical Care
Volume13
Issue number2
DOIs
StatePublished - Apr 1 2007

Keywords

  • Cerebral perfusion pressure
  • Cerebral vasospasm
  • Hemodynamic augmentation
  • Subarachnoid hemorrhage
  • Traumatic brain injury

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