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Critical Care Medicine

Answer 3
  1. It has no significant role except in certain patients who are deteriorating rapidly. Therapeutic hyperventilation using assisted mechanical ventilation (Paco2 < 25 mm Hg) was once considered a cornerstone in the management of TBI because it is causes a rapid reduction in ICP. However, hyperventilation reduces ICP by causing cerebral vasoconstriction with a subsequent reduction in cerebral blood flow. Studies have demonstrated that when hyperventilation is used in children with severe head injury, there is an increased risk of brain ischemia and worse neurologic outcomes. Based on this data, chronic hyperventilation is no longer recommended.5 Short-term hyperventilation, however, has a role in reducing ICP in patients who are rapidly deteriorating before other measures can be instituted.

    5. Bullock R, Chesnut R, Clifton G, et al. Guidelines for the management of severe head injury. New York: Brain Trauma Foundation; 1996.

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