Cerebral vasomotor reactivity in head-injured patients

Abstract

The avoidance of the development of secondary brain damage following head injury is a key point in treating severe brain injury. Recently cerebral perfusionpressure (CPP)-based management, in which volume expansion and vasopressor therapies are often employed to reduce the risk of such secondary brain damage, has improved the long-term neurological outcome as compared with traditional intracranial pressure-based management. However, it is indicated that CPP-based management may possibly induce severe vasogenic edema and intracerebral bleeding, if the patients suffer from disturbances in vascular response ability including vasospasm caused by head injury. Therefore, it is important to know the condition of the vascular response ability, before applying CPP-based management. Recently, there have been many excellent papers about cerebrovascular reactivity, including vasospasm following head injury. The purpose of this review is to evaluate the most advanced diagnostic methods at the bedside as a monitor for checking the disturbance of the cerebral vascular response ability, including vasospasm following head injury, in order to get a much better outcome by CPP-based management for head injury patients.