Ventilatory support in patients with head injuries

Patients with severe head injury are prone to pulmonary complications that result in hypoxemia or hypercarbia, which could worsen their neurological c ondition. A rational ventilatory approach requires a good knowledge of resp iratory and neurological pathophysiology. Airway management is of prime imp ortance in neurological patients. Prophylactic chronic hyperventilation in head trauma is no longer recommended since it could impair cerebral perfusi on, although transient hypocarbia could be of benefit to some patients. The use of low or moderate positive and expiratory pressure levels apparently improves oxygenation without worsening intracranial pressure. Ventilatory m anagement should be closely monitored and adjusted to hemodynamic, respirat ory and neurological status to achieve a good outcome.