Hyperventilation in the head-injured patient: an effective treatment modality?

Mortality and poor functional outcomes remain major problems in patients who experience a severe head injury. Cerebral injury from high intracranial pressure contributes to the head injury. A basic postulate in the care of the head-injured patient is the prevention of secondary cerebral damage through the management and prevention of high intracranial pressure. Hyperventilation, once an established intervention in the treatment and control of intracranial hypertension in patients with severe neurologic injury, has become increasingly controversial. This article reviews (1) the normal physiology of the brain, (2) the pathophysiologic changes that occur during head injury, and (3) the theoretical rationale of hyperventilation and its interaction with nursing care. A case study is presented to highlight how the patient's response to a routine nursing procedure, endotracheal suctioning, may change as a result of hyperventilation.