Blood pressure management in acute head injury

Head injury remains a major cause of preventable death and serious morbidity in young adults. Based on the available evidence, it appears that a cerebral perfusion pressure of 50 to 70 mm Hg is generally adequate to ensure cerebral oxygen delivery and prevent ischemia. However, evidence suggests that perfusion requirements may not only vary across the injured brain but also differ depending on the time since injury. Such heterogeneity, both within and between subjects, suggests that individualized therapy may be an appropriate treatment strategy. Future studies should aim to assess which groups of patients, and what regional pathophysiological derangements, may benefit with improvements in functional outcome from therapeutic increases or decreases in cerebral perfusion pressure beyond these proposed limits. Such functional improvements may be of immense importance to patients and require formal neurocognitive assessments to discriminate improvements.