The manipulation of arterial carbon dioxide levels (PaCO2) is easy, and hyperventilation (HV) has been a common ICP-lowering strategy for over half a century.

However, hyperventilation-induced vasoconstriction is a double-edged sword. It reduces cerebral blood volume and intracranial volume, and therefore, lowers ICP.

We observed huge variability among centres in PaCO2 values and use of HV. Although causal inferences cannot be drawn from these observational data, our results suggest that, in patients with severe intracranial hypertension, HV is not associated with worse long-term clinical outcomes.

Original article: Management of arterial partial pressure of carbon dioxide in the first week after traumatic brain injury: results from the Center-TBI study


David K. MENON. Neurocritical Care Unit, Addenbrooke’s Hospital, Cambridge, UK

Laura BORGSTEDT. Clinic for Anaesthesiology and Intensive Care Medicine – Klinikum rechts der Isar of the Technical University of Munich

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