Table 2.
Evidence table for cerebral perfusion pressure recommendations
| Reference | MAP calibration level 1 | Main findings | Level of evidence 2 | Grade of recommendation 2 |
|---|---|---|---|---|
| Changaris et al., 1987
[5] |
*MAP measured at heart level |
All patients with CPP < 60 mmHg on the second post-injury day died. More patients had a good outcome when CPP > 80 mmHg. |
III |
C |
| McGraw, 1989
[6] |
NA |
The likelihood of good outcome was higher, and mortality lower when CPP > 80 mmHg. |
III |
C |
| Rosner and Daughton, 1990
[7] |
Supine position. Systemic ABP, transducer at same level as ICP |
CPP actively kept >70 mmHg gave the same morbidity rates as previous methods. |
III |
C |
| Cruz, 1998
[8] |
"ICP and MAP levelled in relation to the head tilt" |
Monitoring cerebral extraction of oxygen in conjunction with CPP gave better outcome than when CPP is managed alone. |
III |
C |
| Robertson et al., 1999
[2] |
MAP measures at the same level as ICP |
CPP > 70 mmHg increased the risk of ARDS. |
II |
B |
| Juul et al., 2000
[9] |
*Arterial line, head level |
CPP > 60 mmHg had no influence on outcome. |
III |
C |
| Contant et al., 2001
[1] |
NA |
Increased risk of ARDS when CPP > 70 mmHg. |
III |
C |
| Andrews et al., 2002
[3] |
NA |
Low CPP and hypotension were predictors of death and poor outcome. |
III |
C |
| Clifton et al., 2002
[10] |
NA |
Poor outcome was associated with a CPP < 60 mmHg. No benefit by maintaining CPP > 70 mmHg. |
III |
C |
| Steiner et al., 2002
[11] |
NA |
Optimal CPP for each patient was calculated. Patients whose CPP varied above or below had a worse outcome. |
III |
C |
| Howells et al., 2005 [12] | *MAP measured in mid-axillary line | Patients with intact auto-regulation had better outcomes with CPP > 70 mmHg. Patients with defect auto-regulation had better outcome with ICP targeted care. | III | C |
1Information about how the arterial line was calibrated to measure the mean arterial blood pressure (MAP) was either found in the publication, or obtained from the corresponding author (*). NA: Not available. 2Evidence levels and grades of recommendation, adapted from the Oxford Centre for Evidence-Based Medicine for the UK National Health Service.