Systemic Hemodynamic Monitoring and Blood Pressure Target During Acute Brain Injury

To ensure that cerebral blood flow, perfusion, and oxygen delivery are optimized in patients with acute traumatic brain injury, careful hemodynamic monitoring is necessary. In the context of intracranial hypertension, blood pressure augmentation and volume status manipulation are frequently used to target cerebral perfusion pressure. Following traumatic brain injury, guidelines advise avoiding hypotension and aiming for cerebral perfusion pressure between 60 and 70 mmHg for survival and favorable outcomes. The pulmonary artery catheter has recently been supplanted by less invasive hemodynamic monitoring techniques for intraoperative and intensive care monitoring. These include methods that enable continuous monitoring of cardiac output derivatives and provide dynamic markers for evaluations of volume status, including transpulmonary thermodilution, arterial waveform and pulse contour analysis, and bedside ultrasonography. Goal directed hemodynamic therapy to target guideline specified blood and perfusion pressure goals, while avoiding volume overload, can improve outcomes following brain trauma.