In the management of ICP in TBI, hyperventilation is most appropriate to which scenario?

• A. Briefly for acute herniation
• B. Routine across all patients
• C. Never used
• D. As part of long-term maintenance

Answer: (A)

Hyperventilation lowers arterial carbon dioxide, which causes cerebral vessels to constrict and reduces cerebral blood volume. This quickly lowers intracranial pressure, making it an emergency, time‑critical maneuver in traumatic brain injury when ICP is rising and there are signs of impending herniation. Because the reduced CO2 can also decrease overall cerebral blood flow, risking ischemia if kept for too long, this approach is reserved for a brief, bridge period to definitive treatment rather than routine care or long‑term management. In practice, it’s used to rapidly correct dangerous ICP in acute herniation scenarios, while other measures and definitive therapies are arranged.