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Cerebral blood flow and perfusion monitoring in the critically ill 

Cerebral blood flow and perfusion monitoring in the critically ill
Chapter:
Cerebral blood flow and perfusion monitoring in the critically ill
Author(s):

Samson Sujit Kumar Gaddam

and Claudia S. Robertson

DOI:
10.1093/med/9780199600830.003.0222
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date: 25 October 2021

Prevention of secondary cerebral ischaemic insults is an important management strategy in acute neurological conditions. Monitoring of cerebral perfusion may aid in early identification of ischaemic insults and help with management. A number of tools are available for this purpose. Cerebral perfusion pressure (CPP) is the simplest assessment of cerebral perfusion, but in some cases ischaemia can be present even with a normal CPP. Cerebral blood flow (CBF) imaging, either with computed tomography or magnetic resonance imaging techniques, can provide quantitative regional CBF measurement, but only at a single instance in time. Such studies are valuable in the diagnosis of ischaemia, but are difficult for the management of critically-ill patients. CBF can also be measured within the intensive care unit (ICU), either directly or indirectly through the measurement of cerebral oxygenation. These monitors provide a more continuous measure of CBF, and are more useful in assessing response to treatment. Some of the ICU tools monitor global perfusion and some assess perfusion only in a local area of brain surrounding the monitor. With local monitors, the location of the probe is important for interpretation of the findings.

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