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Updated: Jul 18, 2025
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Point of Care Transcranial Color-Coded Duplex Ultrasound of the Middle Cerebral Artery
Published on: August 9, 2024
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Point-Counterpoint: Cerebral perfusion pressure is a high-risk concept
Sérgio Brasil1, Ronney B Panerai2, Edson Bor-Seng-Shu1
1Division of Neurosurgery, Department of Neurology, School of Medicine University of São Paulo, Brazil.
Summary
Cerebral perfusion pressure (CPP) monitoring in neurocritical care may lead to inaccurate assumptions. Recent physiological insights and clinical practice issues suggest a need to reconsider CPP
Area of Science:
- Neurocritical care
- Cerebrovascular physiology
Background:
- Cerebral perfusion pressure (CPP) is a key metric in neurocritical care.
- It is calculated as mean arterial blood pressure minus intracranial pressure.
Purpose of the Study:
- To discuss recent physiological advances impacting CPP interpretation.
- To highlight bedside practice issues that challenge CPP's utility.
Main Methods:
- Literature review of physiological advances.
- Analysis of clinical practice challenges in neurocritical care.
Main Results:
- Current understanding of cerebral autoregulation has advanced.
- Bedside application of CPP may not accurately reflect tissue perfusion.
Conclusions:
- Relying solely on CPP may lead to flawed clinical decision-making.
- A critical re-evaluation of CPP's role in neurocritical care is warranted.
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