Cerebral perfusion pressure (CPP)

Last edit by Alaric Steinmetz on

Synonyms: CPP

Cerebral perfusion pressure (CPP) plays a central role in neurointensive care and is crucial for maintaining adequate cerebral blood flow.

Definition

CPP is defined as the difference between mean arterial pressure (MAP) and intracranial pressure (ICP):

CPP = MAP – ICP

This relationship shows that CPP is influenced by both MAP and ICP.

Normal Values

The normal CPP value in adults is above 50 mmHg[^2].

Optimization of CPP

Various approaches can be taken to optimize CPP:

  • Increase MAP: This can be achieved through fluid administration or medications that increase blood pressure. An increase in MAP leads to an increased CPP, provided that ICP remains constant.

  • Decrease ICP: A reduction in intracranial pressure can be achieved pharmacologically, such as through sedation or Mannitol or by surgical interventions such as decompressive hemicraniectomy. Lowering ICP has a positive effect on CPP by increasing the difference to MAP.

Clinical Relevance in Trauma

In patients with traumatic brain injury, it has been shown that patients benefit more from a reduction in ICP than an increase in MAP to maintain cerebral perfusion[^1].