More than 30,000 Americans die each year as a result of head injuries. Although destroyed brain cannot be replaced, intensive care can preserve surviving tissue and improve the prognosis of the 50% who are expected to recover. Atelectasis, aspiration, barotrauma, pneumonia, and other respiratory complications are common and lead to further morbidity and mortality. Even patients whose chest radiographs are normal are often hypoxemic. Careful airway control and arterial blood gas management are essential if the disastrous consequences of brain ischemia and intracranial hypertension are to be avoided.
SimmonsRL, MartinAM, HeisterkampCA, DuckerTB. Respiratory insufficiency in combat casualties: II. Pulmonary edema following head injury. Ann Surg1969;170:39–44.
18.
TheodoreJ, RobinED. Speculations on neurogenic pulmonary edema. Am Rev Respir Dis1976;113:405–411.
19.
GordonE.Controlled respiration in the management of patients with traumatic brain injuries. Acta Anaesth Scand1971;15:193–208.
20.
CrockardA.Controlled ventilation in curarized patients with severe head injuries. In: McLaurinRL, ed. Head injuries. Proceedings of the second Chicago symposium on neural trauma. New York: Grune & Stratton Inc, 1976:151–156.
MillerJD. The management of cerebral edema. Br J Hosp Med1979;21:152–166.
23.
PaulRL, PolancoO, TurneyS, McAslanTC, CowleyRA. Intracranial pressure responses to alterations in arterial carbon dioxide pressure in patients with head injuries. J Neurosurg1972;36:714–720.
24.
BedfordRF, PersingJA, PobereskinL, ButlerA.Lidocaine or thiopental for rapid control of intracranial hypertension?Anesth Analg1980;59:435–437.
25.
SchumakerPT, RhodesGR, NewellJC, . Ventilation-perfusion imbalance after head trauma. Am Rev Respir Dis1979;119:33–43.
