rosenberg on heart-brain haemodynamics
DESCRIPTION
Go to www.intensivecarenetwork.com for the audio that goes with these slides. Alex Rosenberg is an intensivist with more of an obsession with all things cardiac, but his experience in a large neuro ICU made him well placed to discuss the interaction between cerebral perfusion pressure, vasopressors and cardiac output in this important neuro topic that is relevant to anyone who looks after patients with injured brains. This is sadly the last talk from BCC3, but don't get too depressed - you can always join us this year in Cairns, or wait for those talks to come out on ICN, and there's always the torrent of superb free media that is flowing out from the smacc conference.TRANSCRIPT
CPP / Vasopressors / Cardiac Output
Alex Rosenberg
Disclosures
• I am not a neuro-intensivist!
• I am interested in haemodynamic monitoring and critical care ultrasound.
CPP
• Systemic Hypotension increases morbidity and mortality from TBI.
• Intracranial hypertension increases morbidity and mortality from TBI.
• CPP = MAP – ICP
Brain Trauma Foundation
• 1995
• CPP>70
Is Low CPP Harmful?
Clinical Data
Brain Trauma Foundation Guidelines 2007
• CPP is a valuable monitoring parameter.
• Critical threshold is between 50 and 60mmHg
• Do not substitute CPP for monitoring and management of either of its constituent parameters.
Is high CPP beneficial?
Good Protoplasm?
79 Year Old Lady with SAH. 59mls/Hr Noradrenaline. Map 62
63 year old SAH MAP 70 Norad @ 23mls/hr
38 year old ICH
46 year old SAH
24Year old TBI
How to monitor?
Take Home Messages
• CPP should be kept 50 – 60.
• Neurosurgical patients have abnormal hearts.
• Cardiac Output is beneficial.
• Non invasive monitoring is possible.
Thank you.