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BJA Advance Access published online on December 10, 2004
British Journal of Anaesthesia, doi:10.1093/bja/aei034
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2004
Accepted October 10, 2004

Clinical Investigation

Non-invasive assessment of cerebral perfusion pressure in brain injured patients with moderate intracranial hypertension

A. R. Edouard 1*, E. Vanhille 1, S. Le Moigno 1, D. Benhamou 1, and J.-X. Mazoit 1

1 Service d'Anesthésie-Réanimation et Unité Propre de Recherche de l'Enseignement Supérieur-Equipe d'Accueil (UPRES-EA 3540), Hôpital de Bicêtre, 94275 Le Kremlin Bicêtre, France

* To whom correspondence should be addressed.
A. R. Edouard, E-mail: alain.edouard{at}bct.ap-hop-paris.fr


  Abstract

Background. A non-invasive estimation of cerebral perfusion pressure (CPP) using transcranial Doppler sonography was assessed in brain-injured patients by comparing conventional measurements of CPP (difference between mean arterial pressure and intracranial pressure) (CPPm) with the difference between APmean and the critical closing pressure of the cerebral circulation (CPPe).

Methods. Twenty adults with bilateral and diffuse brain injuries were included in the study. CPPe was estimated using a formula combining the phasic values of flow velocities and arterial pressure. In group A (n=10) the comparison was repeatedly performed under stable conditions. In group B (n=10) the comparison was performed during a CO2 reactivity test. Covariance analysis was used to assess the relationships.

Results. In group A, CPPe and CPPm were correlated (slope, 0.76; intercept, +10.9; 95% CI, -3.5 to +25.4). During the increase in intracranial pressure (group B) (+1.9 (SD 1.5) mm Hg per mm Hg of PE'CO2) the relationship persisted (slope, 0.55; intercept, +32.6; 95% CI, +16.3 to +48.9) but the discrepancy between the two variables increased as reflected by the increase in bias and variability.

Conclusion. Non-invasive estimation of CPP can be used for brain monitoring of head-injured patients, but the accuracy of the method may depend on the level of intracranial hypertension.

Keywords: brain, cerebral perfusion pressure; brain, intracranial pressure; complications, traumatic brain injury; monitoring, jugular venous oxygen saturation; monitoring, transcranial Doppler ultrasonography.
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Non-invasive estimated cerebral perfusion pressure: relatively inaccurate in brain injured patients
Peter J Davis, et al.
British Journal of Anaesthesia, 31 Jan 2005 [Full text]

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