Hyperventilation in head injury does it do more harm than good?

During the past decade the management of clients with severe head injuries has been influenced by the use of hyperventilation. Increased intracranial pressure (I.C.P.) is the major cause of death following head injury and outcome has been linked to the ability of the practitioner to control intracranial hypertension. Hyperventilation is one method that is frequently employed to control increases in I.C.P. There is no doubt that hyperventilation effectively reduces intracranial pressure, but controversy surrounds the influence that this procedure may inflict upon the cerebral hemodynamic reserve (C.H.R.). The literature indicates that in spite of normal cerebral perfusion pressure, associated with raised I.C.P., that C.H.R. may be compromised. This paper will examine the controversy that surrounds the use of hyperventilation in the client with severe head injury.