Background and aims SPTBI is frequently associated to acute circulatory failure (hypovolemia, vasoplegia, myocardial depression or tamponed). The haemodynamic systemic management objective in SPTBI is an haemodynamic stability, normal cardiac output, and assessment of blood volume status. In this way MSH has an important role to guide the management (volume expansion, vasopressor or inotrope).

The aim of this study is to improve the interest of systematically integration of MSH for management of cerebral perfusion pressure (CPP).

Method Thisprospective study was conducted between April 2013 and April 2014. For each patient with cerebral systemic oligohemia, alteration of the CPP, acute circulatory failure, the assessment of the cardiac output, mean artery pressure, blood volume status were obtained by : echocardiography, estimated continuous cardiac output (esCCO), Oesophageal doppler, NIBP.

Results on a total of 20 patients with SPTBI, 41 measures were realised.

- Cardiac Index was normal (> 3 l/min/m²) in13 patients with cerebral systemic oligohemia in transcranial doppler (TCD).

- Cardiac Index was abnormal < 3 l/min/m² » in 7 patients.

- All patients was treated: o Noradrenaline was introduced in 14 patients with objective of CPP, 2 of them had a profound vasoplegia « DAP < 40 mmHg »: o Volume expansion in 18 patients « fluid responsiveness based on the respiratory variation aortic flow peak velocity, SV, and inferior vena cava »

Conclusion Assessment of CO, blood volume status, vascular resistance based on a systemic monitoring allows the optimisation of PPC evaluated with TCD.