How to Define and Meet Blood Pressure Targets After Traumatic Brain Injury: A Narrative Review

Area of Science:

• Neurocritical care
• Traumatic Brain Injury (TBI)
• Hemodynamic management

Background:

• Severe traumatic brain injury (TBI) presents significant challenges in neurocritical care.
• Meticulous management of hemodynamic parameters, specifically arterial blood pressure (ABP) and cerebral perfusion pressure (CPP), is crucial for optimizing patient outcomes.
• Defining and achieving continuous ABP and CPP targets is a critical aspect of TBI management.

Purpose of the Study:

• To propose a comprehensive approach for defining and meeting continuous ABP and CPP targets in severe TBI.
• To integrate real-time monitoring, individualized cerebral perfusion target setting, and dynamic interventions.
• To address the complexities of hemodynamic management in neurocritical care settings.

Main Methods:

• A narrative review of existing literature, clinical guidelines, and emerging technologies.
• Proposal of a comprehensive approach integrating real-time monitoring and individualized target setting.
• Discussion of advancements in monitoring technologies, including autoregulation-guided ABP/CPP treatment.

Main Results:

• Personalized hemodynamic management is essential due to patient heterogeneity and evolving TBI conditions.
• Advanced monitoring technologies offer a more nuanced understanding of cerebral perfusion dynamics.
• Proactive monitoring strategies enable tailored interventions to optimize ABP/CPP and mitigate secondary brain injury.

Conclusions:

• Challenges include lack of standardized protocols, variability in decision-making, and the need for specialized expertise and software.
• The patient outcome benefit of monitoring-guided ABP/CPP target definitions requires further proof in TBI patients.
• The TBI community should pursue randomized controlled trials to validate personalized ABP/CPP targets and translate potential benefits into clinical practice.