Cerebral Perfusion Pressure and Neurointensive Care

Abstract

Identification of neurointensive care as a sub-discipline distinct from general intensive care corresponded with the introduction of continuous monitoring of intracranial pressure (ICP). At first, most attention focused on the level of ICP regardless of other monitored variables, and management protocols instructed staff to begin treatment at certain threshold levels of elevated ICP. Within a few years, experimental studies of the relationships between arterial pressure, ICP and cerebral blood flow (CBF) had established the importance for cerebral perfusion pressure (CPP), approximated by the differences between arterial and intracranial pressure. Eventually, this information has been assimilated into clinical care protocols and in most neurointensive care units, most emphasis is now placed upon the level of CPP. This brief review follows the development of these ideas and their contemporary application in the management of patients with acute traumatic, hemorrhagic and ischemic brain damage in the neurointensive care unit.