A patient with raised ICP (ICP 28 mmHg, MAP 80 mmHg) is posted for craniotomy for a large cerebral tumour. The cerebral perfusion pressure (CPP) is 52 mmHg. What is the TARGET CPP range in neurocritical care to prevent secondary brain injury?

• A 30–50 mmHg
• B 70–90 mmHg
• C >90 mmHg for neuroprotection
• D 50–70 mmHg ✓

Explanation

CPP = MAP – ICP. Neurocritical care guidelines (BTF, 2016) recommend maintaining CPP between 60–70 mmHg as the therapeutic target in traumatic brain injury; a range of 50–70 mmHg is generally accepted to prevent both cerebral ischaemia (too low CPP) and ARDS/systemic complications from aggressive vasopressor use (too high CPP). This patient's CPP of 52 mmHg is below the safe threshold, requiring either ICP reduction or MAP augmentation. CPP <50 mmHg causes cerebral ischaemia; targeting >90 mmHg increases lung injury risk.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.