However, European guidelines for the management of bleeding trauma patients recommended a target systolic blood pressure of 80 to 100 mmHg until major bleeding has been stopped in the initial phase after trauma for patients without brain injury [11 ] (Figure 1). When traumatic hemorrhagic shock is associated with severe brain injury, cerebral perfusion pressure must be maintained by increasing the arterial pressure to prevent secondary brain injury. Before monitoring the intracranial pressure, we must define the optimal level of arterial pressure by
using transcranial Doppler to determine the best balance between an optimal cerebral perfusion and the risk of increased bleeding (Figure 1) . Transfusion and prevention of acute coagulopathy of trauma