THE MANAGEMENT OF CEREBRAL PERFUSION-PRESSURE AND INTRACRANIAL-PRESSURE AFTER SEVERE HEAD-INJURY

Neurosurgical intervention attempts to minimize secondary central nerv ous system injury after severe head injury through the evacuation of m ass lesions with subsequent manipulation of cerebral perfusion pressur e and intracranial pressure. The normal brain couples blood flow to me tabolic demand through autoregulation of the cerebral vasculature. Aft er severe head trauma and its attendant increase in intracranial press ure, marked alterations in cerebral blood flow and perfusion may occur . Currently, intervention is based on maintenance of coronary perfusio n pressure and aggressive management of intracranial pressure. Both ma y be impacted by manipulation of ventilation, systemic blood pressure and volume status, administration of osmotic diuretics, and head eleva tion. Such therapy in the patient with severe head injury attempts to maintain coronary perfusion pressure and adequate oxygen delivery in a damaged central nervous system with altered hemodynamics and raised i ntracranial pressure.