When is hyperventilation indicated in acute TBI management?

• A. As a temporary rescue maneuver for sudden ICP rise or impending herniation; not long-term
• B. As a routine long-term strategy
• C. Only after 72 hours
• D. Only as a prophylactic measure in all patients

Answer: (A)

In acute TBI, hyperventilation lowers intracranial pressure quickly by reducing arterial CO2, which causes cerebral vasoconstriction and a decrease in cerebral blood volume. But this also reduces cerebral blood flow, risking brain ischemia if used for too long. Because of that, hyperventilation is reserved as a temporary rescue maneuver for sudden ICP spikes or signs of impending herniation, giving time to implement other definitive therapies. It is not employed as a routine long-term strategy, nor used prophylactically for all patients.