Cerebral Resuscitation in Neurocritical Care

Cerebral resuscitation includes the strategies that restore and protect cerebral function after the initial primary damage due to ischemic, hemorrhagic, traumatic, and nontraumatic injury. The goal of cerebral resuscitation is to provide an optimal macro- and micro-milieu to the stunned neuronal tissue by optimizing hemodynamics, glycemic control, metabolic status, and nutrition. Blood pressure targets depend on the underlying primary pathology. While the systolic blood pressure targets in traumatic brain injury range between 100 and 110 mmHg, patients with ischemic stroke need to be maintained at higher pressures, i.e., <220/110 mmHg. Cerebral volumes should be carefully managed using the pharmacologic and non-pharmacologic interventions. Steroids have no role in cerebral edema management exception being bacterial meningitis. Dysglycemia should be avoided, and blood sugar should be maintained between 110 and 180 mg/dL. While normothermia needs to be maintained in most of the patients, it is recommended for neuroprotection after in and out of hospital cardiac arrest. Patients requiring mechanical ventilation should receive adequate analgosedation. The recommend PaO2 is 80–120 mmHg and PaCO2 is 35–45 mmHg. Prompt seizure control, prevention of dyselectrolytemia, and early enteral nutrition should be ensured to prevent the spiral of secondary brain injuries and provide a chance to the salvageable pneumbric zone.