This document discusses using physiology as a target for treating traumatic brain injury (TBI). It summarizes key physiological parameters that should be monitored and targeted in TBI patients, including intracranial pressure (ICP), mean arterial pressure (MAP), partial pressure of brain tissue oxygen (PbtO2), cerebral blood flow (CBF), glucose levels, ventilation, and temperature. Maintaining these physiological markers within certain ranges can help optimize brain mechanics, metabolism and function for TBI patients.

1. Brandon Foreman, MD FACNS
TBI: USING PHYSIOLOGY AS A TARGET

2. WE ALREADY USE PHYSIOLOGY!

3. PbtO2

4. ICP
MAP
O2/PbtO2
EEG
CBF
Autoregulation

5. Mechanics
Metabolism
Function

6. BLOOD PRESSURE 1.0
Ko2013

7. Ko2013,Aries2012
BLOOD PRESSURE 2.0

8. ICP
Chambers 2008, Guiza 2015, Badri 2012; unpublished data

9. PTD0 PTD2 PTD3
CBF Probe
BLOOD FLOW

11. PTD0 PTD2 PTD3
CBF Probe

12. Mechanics
Metabolism
Function

13. GLUCOSE
Oddo 2008

14. Avoid Hypoxia
OR 2.66 for death
Maintain SpO2>95%
Avoid Hyperoxia
Paradoxically reduces CBF
ROS-induced injury
Maintain PaO2 at lowest concertation required
to maintain SpO2>95%
VENTILATION
• Avoid Hyperventilation
• 1 mmHg EtCO2 = 2-4% CBF
• Maintain 35-45 mmHg
Chi2006,Helmerhorst2015,Dumont2010.GoogleImages.

15. Mechanics
Metabolism
Function

16. NEUROVASCULAR COUPLING

17. SEIZURES

18. SPREADING DEPOLARIZATIONS
Vespa1999,Claassen2004,Vespa2005,Vespa2016,Harrings2012,Hartings2015

19. FEVER

20. ICP
PUPILLOMETRY
Source:GoogleImages

21. PHYSIOLOGIC STATES
Sorani 2007, Cohen 2010

22. TAKEAWAY: BUILDING YOUR ELEPHANT
▶ SBP≥110 (≥ 100 in 50-69 year-olds)
▶ MAP>80
▶ ICP≤22
▶ PaCO2 35-45 mmHg
▶ PaO2 lowest possible to maintain adequate O2 sats
▶ Glucose 120-180 mg/dL (6.8-10 mmol/L)
▶ Core Temp < 38.5C
▶ Additional targets:
▶ Cerebral blood flow > 15 ml/100g/min
▶ Brain tissue oxgen > 20 mmHg
▶ cEEG and ECOG
▶ Quantitative pupillometry
THANK YOU !

24. BRAIN TISSUE OXYGEN
PbtO2
Maloney-Wilensky 2009, Oddo 2011, Rosenthal 2008, DeGeorgia 2004