Neurosurgery notes/Trauma/Management of trauma/Non surgical/Blood pressure

Blood pressure

View Details
logo
Parent item
Non surgical

SBP target at

  • ≥100 mm Hg for patients 50 to 69 years old
  • ≥110 mm Hg or above for patients 15 to 49 or over 70 years old may be considered to decrease mortality and improve outcomes.

Hypotension

  • Hypotension (shock) is rarely attributable to head injury except:
    • In terminal stages (i.e., with dysfunction of medulla and cardiovascular collapse)
    • In infancy, where enough blood can be lost intracranially or into the subgaleal space to cause shock
    • Where enough blood has been lost from scalp wounds to cause hypovolemia (exsanguination)
  • Hypotension
    • Defined as a single SBP< 90mm Hg
    • Doubles mortality
    • SBP< 90mm Hg may impair CBF and exacerbate brain injury and should be avoided
  • Should be corrected
    • Initially with intravenous fluid resuscitation
      • Aggressive fluid resuscitation is detrimental, and euvolaemia is the primary cardiovascular goal (Gantner et al., 2014).
      • Types of fluids
        • 0.9% saline is a justified choice despite a lack of evidence of superiority
        • Albumin
          • Associated with increased mortality, possibly secondary to an associated increase in ICP (Cooper et al., 2013)
        • Hypertonic saline
          • Despite interest in the use of hypertonic saline (HS) solutions for fluid resuscitation after TBI, no outcome benefits over isotonic crystalloids have been reported.
    • If not responding then a vasoactive agent
      • Norepinephrine
        • No evidence is the best vasoactive agent
        • Widely used
        • Has a predictable and consistent effect on systemic blood pressure and cerebral haemodynamics

Hypertension

  • Best options to use
  • Sympathomimetic-blocking agents drugs such as β-blocking drugs
    • Propranolol
    • Esmolol
    • Labetalol
  • Centrally acting α receptor agonists
    • Clonidine
    • α-methyldopa