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Consequently, untoward changes in physiologic parameters, including arterial hypotension, hypoxia, hyper- and hypocapnia, hyper- and hypogly- cemia, and fever, as well as seizures, produce what is termed a secondary physiologic insult.
Arterial hypotension, especially in combination with hypoxemia, is a well-documented source of cerebral mor- bidity.13,14 Therefore, a reduction of cardiac output and CPP have to be avoided to prevent further deterioration of
Hypercapnia, hypoxia, and arterial hypotension lead to autoregulatory cerebral vasodilation, which increases CBV and ICP and further diminishes CPP, perpetuating the vicious circle (Fig. 84.4).
Arterial hypotension with a SBP below 90 mm Hg is strongly correlated to poor outcome and has to be avoided in the management of TBI patients.14,116 There exists a smooth U-shaped relationship between systolic or MAP and outcome without any evidence of an abrupt threshold
Neurologic deterioration, poor out- comes, and increased mortality have been reported with baseline blood pressures less than 100/70 mm Hg.203 Com- mon causes of arterial hypotension include hypovolemia, blood loss, decreased cardiac output, myocardial infarc- tion, and arrhythmias.
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