Conclusion
Much more work is needed to answer this controversial
question definitively. However, it is clear from the work
that has been done to date that neurologic critical care
issues such as this can and must be systematically studied
in randomized clinical trials. Additional uncontrolled
clinical series will never provide a convincing answer. In
addition, because the only randomized trial that has
compared the consequences of targeting different levels
of CPP failed to show a long-term benefit and, in fact,
showed a clear detrimental effect (increased incidence
of acute respiratory distress syndrome) with a CPP goal
of greater than 70 mmHg, there is no compelling reason