In traumatic brain injury (TBI), the Lund protocol for ICP management differs from conventional Brain Trauma Foundation guidelines primarily in its use of:
- A Low CPP targets (50 mmHg) with volume loading and cerebral vasoconstriction reduction ✓
- B Hyperventilation to PaCO₂ <30 mmHg
- C High CPP targets (>70 mmHg) with vasopressors
- D Prophylactic decompressive craniectomy
Correct answer: A. Low CPP targets (50 mmHg) with volume loading and cerebral vasoconstriction reduction
Explanation
The Lund protocol aims to reduce cerebral blood volume by: lowering CPP targets (50–70 mmHg in adults), using alpha-2 agonists (clonidine/metoprolol) to reduce sympathetic vasoconstriction and cerebral blood flow, maintaining normal plasma oncotic pressure, and avoiding catecholamines. This contrasts with BTF guidelines which target CPP 60–70 mmHg with vasopressors. The Lund protocol hypothesises that high CPP with intact BBB leads to cerebral oedema formation. Both approaches have clinical advocates.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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