1. Intracranial pressure and cerebral perfusion pressure in patients developing brain death.
- Author
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Salih F, Holtkamp M, Brandt SA, Hoffmann O, Masuhr F, Schreiber S, Weissinger F, Vajkoczy P, and Wolf S
- Subjects
- Adolescent, Adult, Aged, Biomarkers, Blood Pressure physiology, Critical Care, Female, Glasgow Coma Scale, Humans, Male, Middle Aged, Predictive Value of Tests, Retrospective Studies, Young Adult, Brain blood supply, Brain Death physiopathology, Brain Injuries physiopathology, Cerebrovascular Circulation physiology, Intracranial Pressure physiology
- Abstract
Purpose: We investigated whether a critical rise of intracranial pressure (ICP) leading to a loss of cerebral perfusion pressure (CPP) could serve as a surrogate marker of brain death (BD)., Materials and Methods: We retrospectively analyzed ICP and CPP of patients in whom BD was diagnosed (n = 32, 16-79 years). Intracranial pressure and CPP were recorded using parenchymal (n = 27) and ventricular probes (n = 5). Data were analyzed from admission until BD was diagnosed., Results: Intracranial pressure was severely elevated (mean ± SD, 95.5 ± 9.8 mm Hg) in all patients when BD was diagnosed. In 28 patients, CPP was negative at the time of diagnosis (-8.2 ± 6.5 mm Hg). In 4 patients (12.5%), CPP was reduced but not negative. In these patients, minimal CPP was 4 to 18 mm Hg. In 1 patient, loss of CPP occurred 4 hours before apnea completed the BD syndrome., Conclusions: Brain death was universally preceded by a severe reduction of CPP, supporting loss of cerebral perfusion as a critical step in BD development. Our data show that a negative CPP is neither sufficient nor a prerequisite to diagnose BD. In BD cases with positive CPP, we speculate that arterial blood pressure dropped below a critical closing pressure, thereby causing cessation of cerebral blood flow., (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Published
- 2016
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