Rosenberg on Heart-Brain Haemodynamics
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Transcript of Rosenberg on Heart-Brain Haemodynamics
CPP / Vasopressors / Cardiac Output
Alex Rosenberg
Disclosures
• I am not a neuro-intensivist!
• I am interested in haemodynamic monitoring and critical care ultrasound.
CPP
• Systemic Hypotension increases morbidity and mortality from TBI.
• Intracranial hypertension increases morbidity and mortality from TBI.
• CPP = MAP – ICP
Brain Trauma Foundation
• 1995
• CPP>70
Is Low CPP Harmful?
Clinical Data
Brain Trauma Foundation Guidelines 2007
• CPP is a valuable monitoring parameter.
• Critical threshold is between 50 and 60mmHg
• Do not substitute CPP for monitoring and management of either of its constituent parameters.
Is high CPP beneficial?
Good Protoplasm?
79 Year Old Lady with SAH. 59mls/Hr Noradrenaline. Map 62
63 year old SAH MAP 70 Norad @ 23mls/hr
38 year old ICH
46 year old SAH
24Year old TBI
How to monitor?
Take Home Messages
• CPP should be kept 50 – 60.
• Neurosurgical patients have abnormal hearts.
• Cardiac Output is beneficial.
• Non invasive monitoring is possible.
Thank you.