• Michael N Diringer and Yekaterina Axelrod.
• Neurology/Neurosurgery Intensive Care Unit, Barnes-Jewish Hospital, Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA. diringerm@neuro.wustl.edu
• Curr Opin Crit Care. 2007 Apr 1;13(2):156-62.

Purpose Of ReviewThe intent of this manuscript is to summarize the pathophysiologic basis for hemodynamic manipulation in subarachnoid hemorrhage and traumatic brain injury, highlight the most recent literature and present expert opinion on indications and use.Recent FindingsHemodynamic augmentation with vasopressors and inotropes along with hypervolemia are the mainstay of treatment of vasospasm due to subarachnoid hemorrhage. Considerable variation continues to exist regarding fluid management and the use of vasopressors and inotropes. Blood pressure augmentation, volume expansion and cardiac contractility enhancement improve cerebral blood flow in ischemic areas, ameliorate vasospasm and improve clinical condition. In patients suffering from severe traumatic brain injury, while every attempt is made to control intracranial hypertension, cerebral perfusion-directed therapy with fluids and vasopressors is also used to keep cerebral perfusion pressure above 60-70 mmHg. Yet, recent observations suggest that posttraumatic mitochondrial dysfunction has been proposed as an alternative explanation for lower cerebral blood flow after acute trauma.SummaryHemodynamic manipulation is routinely used in the management of patients with acute vasospasm following subarachnoid hemorrhage and severe head injury. The rationale is to improve blood flow to the injured brain and prevent secondary ischemia.

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