Early results using active treatment of CPP as the primary therapeutic end point in the management of patients with traumatic brain injury (TBI)64 were encouraging. Importantly, we demonstrated that CPP could be iatrogenically elevated by inducing systemic hypertension without potentiating mortality from vasogenic edema and uncontrolled intracranial hypertension.
Subsequently, techniques have evolved from this model (Figs. 1 and 3) that form a coherent approach for managing the patient with TBI and have led to testing two closely related hypotheses: 1) management of CPP as the primary goal of therapy will yield lower mortality than that achieved with traditional, ICP-based techniques; and 2) management of CPP will result in higher Glasgow Outcome Scale (GOS)24 scores than traditional methods of therapy.
The authors wish to thank the neurosurgical faculty for their cooperation and support in the collection of this data. We sincerely thank Mrs. Debbie Mielke for the preparation of this manuscript. Special thanks go to the University of Alabama at Birmingham's Injury Control Research Center's Epidemiology and Surveillance Work Group for review of the manuscript, data, and statistical methods.
Jenkins LWMoszynski KLyeth BGet al: Increased vulnerability of the mildly traumatized rat brain to cerebral ischemia: the use of controlled secondary ischemia as a research tool to identify common or different mechanisms contributing to mechanical and ischemic brain injury. Brain Res 477:211–2241989Brain Res 477:
Lundberg N: Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Scand Suppl 149:1–1931960Lundberg N: Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Scand Suppl 149:
Moore FDBrennan MF: Surgical injury: body composition, protein metabolism, and neuroendocrinology. Nitrogen flux and the effects of substrate provision; changing priorities of muscle and wound; anabolic convalescenceAmerican College of Surgeons (eds): Manual of Surgical Nutrition. Philadelphia: WB Saunders1975169–222Manual of Surgical Nutrition.
Yoshida AShima TOkada Yet al: Outcome of patients with severe head injury—evaluation by cerebral perfusion pressureNakamura NHashimoto TYasue M (eds): Recent Advances in Neurotraumatology. Tokyo: Springer-Verlag1993309–312Recent Advances in Neurotraumatology.
This study was supported, in part, by Grant No. R49/CCR403641 from the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention—National Center for Injury Prevention and Control to the University of Alabama at Birmingham, Injury Control Research Center.