Beyond intracranial pressure: optimization of cerebral blood flow, oxygen, and substrate delivery after traumatic brain injury
Open accessAbstract
Monitoring and management of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) is a standard of care after traumatic brain injury (TBI). However, the pathophysiology of so-called secondary brain injury, i.e., the cascade of potentially deleterious events that occur in the early phase following initial cerebral insult-after TBI, is complex, involving a subtle interplay between cerebral blood flow (CBF), oxygen delivery and utilization, and supply of main cerebral energy substrates (glucose) to the injured brain. Regulation of this interplay depends on the type of injury and may vary individually and over time. In this setting, patient management can be a challenging task, where standard ICP/CPP monitoring may become insufficient to prevent secondary brain injury. Growing clinical evidence demonstrates that so-called multimodal brain monitoring, including brain tissue oxygen (PbtO2), cerebral microdialysis and transcranial Doppler among others, might help to optimize CBF and the delivery of oxygen/energy substrate at the bedside, thereby improving the management of secondary brain injury. Looking beyond ICP and CPP, and applying a multimodal therapeutic approach for the optimization of CBF, oxygen delivery, and brain energy supply may eventually improve overall care of patients with head injury. This review summarizes some of the important pathophysiological determinants of secondary cerebral damage after TBI and discusses novel approaches to optimize CBF and provide adequate oxygen and energy supply to the injured brain using multimodal brain monitoring.
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The first stages of brain injury after head trauma are characterized by direct tissue damage and impaired regulation of cerebral blood flow and metabolism.
“Regarding the general pathophysiology of TBI, the first stages of brain injury after head trauma are characterized by direct tissue damage and impaired regulation of cerebral blood flow (hypoperfusion or hyperperfusion) and metabolism (93,97).”
From Pituitary Dysfunction After Traumatic Brain Injury: A Clinical and Pathophysiological Approach (2015) · cites this paper as [93]
The Introduction describes primary lesions from the initial trauma followed by early secondary injury involving blood flow and energy dysfunction. The Macrovascular dysfunction and Energy dysfunction sections support impaired blood-flow regulation, hypoperfusion, and altered metabolism. Our copy does not substantiate hyperperfusion as an early post-traumatic disturbance, so that part of the citing sentence remains unsupported. (LLM, conf=0.82)
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Self-citation
- Authors
- Bouzat, P., Sala, N., Payen, J.-F., & Oddo, M.
- Affiliations
- Centre Hospitalier Universitaire Vaudois (CH)
- Université Joseph Fourier (FR)
- Corresponding author
- Oddo, Mauro
- Venue
- Annals of Intensive Care
- Publisher
- Elsevier BV
- Published
- 2013
- Volume
- 3
- Issue
- 1
- Pages
- 23
- ISSN
- 2110-5820 (ISSN-L)
- PMC
- PMC3716965
- OpenAlex
- W2104099050
- Cited by
- 126
- References
- 76
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 13 · 2023: 9 · 2022: 11 · 2021: 17 · 2020: 9 · 2019: 6 · 2018: 3 · 2017: 8 · 2016: 11 · 2015: 12 · 2014: 11 · 2013: 2
- FWCI
- 7.62
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Annals of Intensive Care (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- IRIS (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Neurology › Intracerebral and Subarachnoid Hemorrhage Research
- Keywords
- traumatic brain injury, secondary brain injury, cerebral blood flow, cerebral oxygen delivery, intracranial pressure, cerebral perfusion pressure, multimodal brain monitoring, cerebral oxygenation, cerebral microdialysis, transcranial Doppler, cerebral hypoxia
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