Hyperventilation therapy for control of posttraumatic intracranial hypertension

Daniel Agustín Godoy, Ali Seifi, David Garza, Santiago Lubillo-Montenegro, Francisco Murillo-Cabezas

Research output: Contribution to journalReview article

5 Citations (Scopus)

Abstract

During traumatic brain injury, intracranial hypertension (ICH) can become a life-threatening condition if it is not managed quickly and adequately. Physicians use therapeutic hyperventilation to reduce elevated intracranial pressure (ICP) by manipulating autoregulatory functions connected to cerebrovascular CO2 reactivity. Inducing hypocapnia via hyperventilation reduces the partial pressure of arterial carbon dioxide (PaCO2), which incites vasoconstriction in the cerebral resistance arterioles. This constriction decrease cerebral blood flow, which reduces cerebral blood volume and, ultimately, decreases the patient's ICP. The effects of therapeutic hyperventilation (HV) are transient, but the risks accompanying these changes in cerebral and systemic physiology must be carefully considered before the treatment can be deemed advisable. The most prominent criticism of this approach is the cited possibility of developing cerebral ischemia and tissue hypoxia. While it is true that certain measures, such as cerebral oxygenation monitoring, are needed to mitigate these dangerous conditions, using available evidence of potential poor outcomes associated with HV as justification to dismiss the implementation of therapeutic HV is debatable and remains a controversial subject among physicians. This review highlights various issues surrounding the use of HV as a means of controlling posttraumatic ICH, including indications for treatment, potential risks, and benefits, and a discussion of what techniques can be implemented to avoid adverse complications.

Original languageEnglish (US)
Article number250
JournalFrontiers in Neurology
Volume8
Issue numberJUL
DOIs
StatePublished - Jul 17 2017

Fingerprint

Intracranial Hypertension
Hyperventilation
Therapeutic Uses
Cerebrovascular Circulation
Therapeutics
Hypocapnia
Physicians
Brain Hypoxia-Ischemia
Partial Pressure
Intracranial Pressure
Arterioles
Vasoconstriction
Constriction
Carbon Dioxide

Keywords

  • Cerebral hypoxia
  • Cerebral ischemia
  • Hyperventilation
  • Hypocapnia
  • Intracranial hypertension
  • Intracranial pressure
  • Severe traumatic brain injury

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Hyperventilation therapy for control of posttraumatic intracranial hypertension. / Godoy, Daniel Agustín; Seifi, Ali; Garza, David; Lubillo-Montenegro, Santiago; Murillo-Cabezas, Francisco.

In: Frontiers in Neurology, Vol. 8, No. JUL, 250, 17.07.2017.

Research output: Contribution to journalReview article

Godoy, Daniel Agustín ; Seifi, Ali ; Garza, David ; Lubillo-Montenegro, Santiago ; Murillo-Cabezas, Francisco. / Hyperventilation therapy for control of posttraumatic intracranial hypertension. In: Frontiers in Neurology. 2017 ; Vol. 8, No. JUL.
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