MAP vs SBP

There are a lot of times where a neurologist will not want to treat the BP until the SBP >180 or even >200, such as in cases of ischemic stroke...lowering the BP too much would deprive the brain of blood, O2 and nutrients.

I don't work on a neuro floor but all of our docs go by "Keep MAP >____" as opposed to the SBP.

Great post.

Are you a neuro critical care team? Again, it just doesn't make sense when your cpp is calculated via map.

The reason I ask is that we have put people on phenylephrine, norepinephrine, vasopressin, and epinephrine to reach ridiculous map goals via sbp (and most time neurosurgeons won't believe our artlines) while these patients maps are in the 140s to maintain a sbp 180-200.

Micu goals are maps usually greater than 55-65.

Cticu keeps there heart maps 60-80 post op.

Sicu uses maps.

Just seems like a much more definitive number.

MAP is a more consistent measurement and is the better perfusion indicating metric. BP is dynamic, but overpressure injury in neuro is going to come from the peak overpressure, SBP. So I'd imagine that the parameters are built upon the measurement reflecting the problem being addressed, promoting cerebral perfusion vs protecting against anyeurism/hemmorage. Or so I understand it... someone tell me if I am way off.

I was only asking about triple H therapy for vasospasm patients.

I think we would have better cardiac outcome with the same neuro outcome if we used maps. A lot of times these patients require 5 pressors and inotropes to get the patients sbp to 200. Meanwhile there ef goes from normal to 20% fast.

We used MAP when we do hhh therapy in yhe neuro icu I worked in. MAP is most consistent. Our goals were usually 80-130.

On my NSICU we use sbp unless the patient had a ventric or Codman placed in which case our neuro surgs use cpp parameters.

I'm a newer ICU nurse, but I asked the same question of one of our Intensivist docs. He stated that current research suggests that for any patient with risk of increased ICP should maintain a MAP above 70 or more depending on physician preference since it is shown that 65 is needed for sufficient profusion and the extra is needed to perfuse the brain tissue in order to counteract the added pressure from swelling/bleeding or whatever is raising the ICP. For other patients he stated that often it just falls to physician preference and for him he titrates vasoconstrictive meds based on a SBP when the patient's baseline pulse pressure is widened. This is because the relative low DBP's can greatly affect what MAP calculation and make it less accurate in relflecting perfusion.... This helped me, I hope it helps you too.