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Is CPP therapy beneficial for all patients with high ICP?
Acta Neurochirurgica. Supplement
|August 10, 2002
Summary
Elevating mean arterial pressure (MAP) to treat intracranial hypertension (ICP) increased ICP in most patients. This intervention is only indicated for select patients with high Glasgow Coma Scale scores and low jugular venous oxygen saturation.
Area of Science:
- Neurocritical care
- Intensive care medicine
- Neurology
Background:
- Induced blood pressure elevation is used for intracranial hypertension.
- Concerns exist regarding potential ICP increases with blood pressure elevation.
Purpose of the Study:
- To test the hypothesis that increasing mean arterial pressure (MAP) decreases intracranial pressure (ICP).
Main Methods:
- 47 studies on 23 intubated head injury patients.
- Continuous monitoring of MAP and jugular venous oxygen saturation (SjvO2).
- MAP increased using phenylephrine; statistical analysis included Pearson correlation, t-test, and logistic regression.
Main Results:
- Increasing MAP decreased ICP in 38.3% of studies.
- Increasing MAP increased ICP in 61.7% of studies.
- ICP decrease associated with MAP increase in patients with high GCS and low SjvO2.
Conclusions:
- Increasing MAP predominantly increased ICP in head injury patients.
- MAP elevation therapy is selectively indicated for patients with high GCS, low SjvO2, and elevated ICP.