The use of positive pressure and hyperventilation in traumatic brain injury
DOI:
https://doi.org/10.55892/jrg.v9i20.2997Keywords:
Traumatic brain injury, Intracranial pressure, Hyperventilation, Mechanical ventilationAbstract
Ventilatory management in traumatic brain injury (TBI) remains a subject of clinical controversy, particularly regarding the use of positive pressure ventilation and hyperventilation as strategies for controlling intracranial pressure (ICP). The research problem guiding this study is to analyze, in light of evidence published between 2020 and 2026, to what extent such interventions contribute to reducing intracranial hypertension without aggravating secondary brain injury. The overall objective is to critically examine the applicability, pathophysiological limitations, and clinical repercussions of these strategies in moderate and severe TBI. Methodologically, this is a critical narrative review, based on recent international guidelines, clinical trials, and systematic reviews indexed in biomedical databases. The results indicate that positive pressure ventilation is essential for maintaining adequate oxygenation, but elevated levels of positive end-expiratory pressure can compromise cerebral venous return and increase ICP. Regarding hyperventilation, its prophylactic use is discouraged, being recommended only temporarily in situations of imminent herniation, due to the risk of excessive cerebral vasoconstriction and secondary ischemia. It is concluded that both interventions should be individualized, guided by multimodal monitoring and rigorous hemodynamic parameters, avoiding general approaches. Ventilatory management in TBI requires a balance between ICP control and preservation of cerebral perfusion, at the risk of neurological deterioration.
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