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DOI: 10.1055/s-0045-1809560
HYPERVENT-CHECK: A Checklist for Therapeutic Hyperventilation in Neurocritical Care

Introduction
In the past 30 years, changing evidence has led professional societies to update their position regarding therapeutic hyperventilation (HV). The Brain Trauma Foundation 2017 guidelines[1] discourage prophylactic HV (PaCO2 < 30 mm Hg) in the initial 24 hours following severe traumatic brain injury due to the risk of worsening cerebral ischemia and eliminating any neuroprotective effect. Instead, they endorse restricted HV as a temporary “rescue” intervention in the context of acute, life-threatening intracranial hypertension—ideally only until definitive therapies (e.g., osmotherapy, decompressive surgery) can be established.[1] Likewise, the American Association of Neurological Surgeons and the Neurocritical Care Society have endorsed these recommendations, noting that extended hypocapnia can be detrimental by impairing microcirculatory perfusion and autoregulatory function.[2] Despite the presence of these concordant statements, clinical practice remains heterogeneous.
Publication History
Article published online:
13 June 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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