Traumatic Brain Injury

Question 1

How does one manually calculate MAP from NIBP?

Answer 1

MAP = [(2xDBP) + SBP]/3

Question 2

What is the Brain Trauma Foundation (4th ed) recommendations for BP targets in severe TBI in adults?

Answer 2

Level III: may decrease mortality and improve outcomes

- Maintain SBP at ≥100 mm Hg for patients 50 to 69 years old
- Maintain SBP at ≥110 mm Hg or above for patients 15 to 49 or over 70 years old

Question 3

What is the Brain Trauma Foundation (4th ed) recommendations for ICP targets in severe TBI in adults?

Answer 3

Level IIb:
- Treat ICP above 22 mm Hg is recommended because values above this level are associated with increased mortality.

Question 4

What is the Brain Trauma Foundation (4th ed) recommendations for CPP targets in severe TBI in adults?

Answer 4

Level IIb:
- The recommended target cerebral perfusion pressure (CPP) value for survival and favorable outcomes is between 60 and 70 mm Hg.
- Whether 60 or 70 mm Hg is the minimum optimal CPP threshold is unclear and may depend upon the patient’s autoregulatory status.

Level III:
- Avoiding aggressive attempts to maintain CPP above 70 mmHg with fluids and pressors may be considered because of the risk of adult respiratory failure
- There is a view that patients with intact autoregulation are best served by higher CPP values while pressure-passive patients with dysfunctional pressure autoregulation do better with lower CPP values.