From the Research
For patients with subdural hematoma (SDH), blood pressure management typically aims to maintain mean arterial pressure (MAP) between 80-110 mmHg, as recommended by the Emergency Neurological Life Support (ENLS) guidelines 1.
Key Considerations
- The goal is to balance the risk of hematoma expansion against adequate cerebral perfusion.
- In acute SDH with elevated intracranial pressure (ICP), maintaining cerebral perfusion pressure (CPP) above 60 mmHg is crucial, calculated as MAP minus ICP.
- Blood pressure goals should be individualized based on the patient's baseline blood pressure, age, comorbidities, and neurological status.
- A recent study found that maintaining SBP between 100-150 mmHg or below 180 mmHg did not show a statistical difference in mortality or secondary outcomes in acute traumatic SDH patients 2.
Management Approach
- First-line medications for blood pressure control are not explicitly stated in the provided evidence, but typically include agents that can be titrated for precise control.
- Avoid aggressive blood pressure reduction, as this may compromise cerebral blood flow and worsen neurological outcomes.
- Continuous arterial line monitoring is recommended for precise blood pressure management.
Rationale
The rationale for these parameters is to prevent secondary brain injury by maintaining adequate cerebral perfusion while minimizing the risk of hematoma expansion or rebleeding, thus prioritizing morbidity, mortality, and quality of life outcomes.