Intracranial pressure and autoregulation in trauma

Traumatic brain injury (TBI) is a common and often devastating injury that can have widespread impact on patients and their loved ones. Traumatic injury to the brain initiates a cascade of molecular and cellular events that often increase cerebral edema and in turn contribute to elevated intracranial pressure (ICP). Elevated ICPs can negatively impact cerebral perfusion pressure (CPP) and, ultimately, cerebral blood flow (CBF). In healthy brain, cerebral autoregulation allows the brain to maintain a constant CBF across a range of blood pressures and ICPs; however, this mechanism is often impaired in the setting of traumatic injury. While control of ICP has historically been a cornerstone in the management of TBI, more recently, increasing recognition of the role of cerebral autoregulation has led to the recognition that TBI management decisions must be executed on a patient-to-patient basis, with the patient's autoregulatory status an important component to consider.