Which of the following TBI patients has a cerebral perfusion pressure in the appropriate range?
a) A 6 month-old with MAP = 45 mmHg and ICP = 10 mmHg
b) A 26 month-old with MAP = 60 mmHg and ICP = 20 mmHg
c) A 26 month-old with MAP = 80 mmHg and ICP = 30 mmHg
d) A 12 year-old with MAP = 80 mmHg and ICP = 30 mmHg
e) A 12 year-old with MAP = 100 mmHg and ICP = 50 mmHg
Answer c. CPP is calculated by the formula MAP-ICP. In the future, we may be able to better target specific CPP goals to an individual patient based on the patient’s autoregulation. However, based on current TBI guidelines the optimal CPP is believed to depend on age, with infants, toddlers, and adolescents requiring 40, 50, and 60 mmHg CPP, respectively. Based on these guidelines, only answer C has a high-enough CPP and the others should receive therapies to increase BP or decrease ICP, or both.