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(Chest. 2005;127:1812-1827.)
© 2005 American College of Chest Physicians

Hyperventilation in Head Injury*

A Review

Nino Stocchetti, MD; Andrew I.R. Maas, MD, PhD; Arturo Chieregato, MD and Anton A. van der Plas, MD

* From the Neuroscience ICU (Drs. Stocchetti and Chieregato), Ospedale Maggiore Policlinico, Milan University, IRCCS, Milan; Department of Intensive Care Medicine (Dr. Chieregato), Ospedale Bufalini, Cesna, Italy; the Departments of Neurosurgery (Dr. Maas) and Intensive Care Medicine (Dr. van der Plas), Erasmus Medical Center, Rotterdam, the Netherlands.

Correspondence to: Nino Stocchetti, MD, Terapia Intensiva Neuroscienze, Padiglione Beretta Neuro, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy; e-mail stocchet{at}policlinico.mi.it

The aim of this review was to consider the effects of induced hypocapnia both on systemic physiology and on the physiology of the intracranial system. Hyperventilation lowers intracranial pressure (ICP) by the induction of cerebral vasoconstriction with a subsequent decrease in cerebral blood volume. The downside of hyperventilation, however, is that cerebral vasoconstriction may decrease cerebral blood flow to ischemic levels. Considering the risk-benefit relation, it would appear to be clear that hyperventilation should only be considered in patients with raised ICP, in a tailored way and under specific monitoring. Controversy exists, for instance, on specific indications, timing, depth of hypocapnia, and duration. This review has specific reference to traumatic brain injury, and is based on an extensive evaluation of the literature and on expert opinion.

Key Words: cerebral ischemia • hyperventilation • intracranial pressure • traumatic brain injury




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