Optimal Arterial Pressure Transducer Positioning for Neurocritical Care Patients: A Review

This narrative review addresses the critical issue of arterial transducer positioning for cerebral perfusion pressure (CPP) measurement in neurocritical care. Despite CPP's importance in guiding management, optimal transducer placement remains ambiguous and unaddressed by current guidelines. We synthesized evidence from 20 relevant articles to inform standardization efforts. Key findings include a 10-12 mmHg CPP discrepancy between phlebostatic axis and Monro foramen transducer locations at 30° head elevation. There is no consensus on anatomical landmarks for "head-level" measurement, and only one guideline explicitly advises against the phlebostatic axis approach. Limited clinical evidence suggests increased institutionalization rates for patients with measurement discrepancies. Emerging dual-transducer strategies aim to address these challenges. The review highlights significant variability in CPP measurement practices, potentially impacting patient care and research interpretation. We emphasize the urgent need for standardized protocols and improved reporting in research. Addressing this variability is crucial for optimizing neurocritical care management and enhancing research comparability. Our findings underscore the importance of consistent arterial transducer positioning in neurocritical care and call for further research to establish evidence-based standardization, ultimately improving patient outcomes and research quality in this critical field.