Cerebral perfusion pressure thresholds in TBI

CPP target range: 50 – 70 mm Hg

Patients with intact pressure  auto-regulation tolerate higher target CPP

Based on:

Aggressive attempts to maintain CPP > 70 mm Hg risk pulmonary oedema, cardiac failure, ARDS (Level II evidence)

CPP < 50 mm Hg should be avoided (Level III evidence)

Brain Trauma Foundation Guidelines.

https://www.braintrauma.org/coma-guidelines/searchable-guidelines/

 

TCI Neuroanaesthesia

Effect site:
Propofol 3 (1-4)
Remifentanil 5 (3-8)

Titrate slowly to avoid large bolus/swings

‘rule of 8’ i.e. prop + remi = 8