- 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.