The focus in Rosner’s Cranial Perfusion Pressure management strategy is on the cerebral perfusion pressure and cerebral blood flow with the presumption of an intact pressure autoregulation.
Low Cranial Perfusion Pressure stimulates cerebral vasodilatation as a part of cerebral blood flow (CBF) autoregulation, thus increasing cerebral blood volume (CBV), which in turn increases intracranial pressure (ICP) and reduces CPP further, thus setting up a vicious cycle.
If mean arterial pressure (MAP) is increased under these circumstances, Cranial Perfusion Pressure increases above the lower limit of autoregulation and causes cerebral vasoconstriction and reduction of ICP.
Pharmacologically-induced increase in mean arterial pressure (MAP) and CPP to improve CBF is recommended.
Rosner et al reported 59% favourable outcome and 29% mortality in his series of 158 patients with GCS <7 where the Cranial Perfusion Pressure was maintained above 70 mm Hg.