Traumatic Brain Injury CPP — FRCA Final MCQ

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ModerateNeuroanaesthesiaTraumatic Brain Injury CPPFRCA Final

A 42-year-old man sustains a severe traumatic brain injury. CT of the head shows an acute subdural haematoma with 12 mm midline shift. His intracranial pressure is 32 mmHg and his mean arterial pressure is 85 mmHg. What is his cerebral perfusion pressure, and is it adequate?

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Correct answer: C — 53 mmHg – inadequate

The correct answer is C. Cerebral perfusion pressure is calculated as CPP = MAP − ICP. Therefore, CPP = 85 − 32 = 53 mmHg. The RCoA quality improvement standard identifies a CPP target of 60–70 mmHg in traumatic brain injury, so 53 mmHg is inadequate and risks insufficient cerebral blood flow, particularly when autoregulation is impaired. Management must urgently address the raised ICP and ensure an appropriate MAP while definitive neurosurgical treatment is arranged. Option D gives the correct calculation but incorrectly calls it adequate. Option E adds MAP and ICP. Option B reports the ICP rather than CPP, and option A reports the MAP alone.

Reference: Royal College of Anaesthetists. Raising the Standards: A Compendium of Audit Recipes for Continuous Quality Improvement in Anaesthesia, 4th edition, section 9.5, Monitoring and targeting mean arterial pressure. 2020. https://rcoa.ac.uk/media/15636