Mechanical ventilation in acute traumatic coma is comprehensively approached, by means of comparatively reviewing the pertinent literature. Multivariate clinico-physiologic-therapeutic aspects are presented and discussed, and a proposition is made for ventilatory optimization under circumstances of predominantly diffuse acute brain insults. A novel technique is introduced for practical, bedside quantification of ventilatory adjustments. This technique allows simultaneous optimization of intracranial pressure and global cerebral extraction of oxygen. The latter represents therapeutic coupling between global cerebral blood flow and oxygen metabolism.
cerebral hemometabolism; acute intracranial hypertension; ventilatory optimization; multivariate physiologic therapy