Which of the following are the important parameters to be maintained in a patient with head trauma? 1. MAP 70-80 mm Hg (mean arterial pressure) 2. Intracranial pressure < 20 mm Hg 3. Cerebral perfusion pressure > 60 mm Hg 4. Na > 140 mEq/L Select the correct answer using the code given below.
1, 2 and 3
The correct answer is 1, 2 and 3. Neurotrauma care aims to prevent secondary brain injury from hypoxia, hypotension and intracranial hypertension. A MAP of about 70-80 mm Hg is maintained because even one episode of systolic pressure below 90 mm Hg roughly doubles mortality. ICP is kept below 20 mm Hg, above which tiered therapy is triggered (head-end elevation, sedation, mannitol or hypertonic saline, CSF drainage, decompressive craniectomy). Cerebral perfusion pressure (MAP minus ICP) is kept above 60 mm Hg (Brain Trauma Foundation target 60-70) since autoregulation is impaired after trauma.
Statement 4, sodium greater than 140 mEq/L, is not a target. Normonatraemia (135-145) is the goal; hypotonic fluids are avoided, and mild hypernatraemia is only a consequence of hypertonic saline given for raised ICP. Hence all options containing statement 4 are wrong.
Key point: Memorise ICP less than 20 mm Hg, CPP greater than 60 mm Hg, adequate MAP, with strict avoidance of hypoxia and hypotension.
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Select the correct answer using the code given below.
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