• Prevention of Secondary Ischemic Insults After Severe Head Injury

    • Feb 28, 2022

    • This is a randomized control trial with patients assigned to protocols targeting cerebral blood flow (CBF) or intracranial pressure (ICP)
    • The outcomes included frequency of jugular venous desaturation, occurrences of refractory intracranial hypertension, and long term neurologic outcome
    • 189 patients who were admitted to a single level 1 hospital with severe head injury and comatose state were included.
    • In the CBF group cerebral, perfusion pressure (CPP) was kept at >70 mmHg while in the ICP group CPP was kept at >50mmHg.  Hyperventilation may be used up to a PaCO2 of 25-30 Torr in the ICP group alone
    • CBF protocol had a decreased frequency of jugular venous desaturations, no difference or higher occurrence of refractory ICPs, and no difference in long term neurologic outcome
    • Although the occurrences of hematoma expansion and renal failure were not different between groups, those in the CSF targeted protocol had a 5x increase in frequency of adult respiratory distress syndrome
    • Although secondary brain injury as measured by jugular venous desaturations can be reduced with a protocol that targets a goal CBF, the adverse effects of such a strategy may offset the potential benefits.

     Robertson CS, Valadka AB, Hannay HJ, Contant CF, Gopinath SP, Cormio M, Uzura M, Grossman RG. Crit Care Med. 1999 Oct;27(10):2086-95. doi: 10.1097/00003246-199910000-00002. PMID: 10548187.

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site here. Privacy Policy