Key messages

• Respiratory complications are an important cause of morbidity and mortality in neurosurgical patients.

• Normal arterial blood gases are a prerequisite for good neurological recovery after brain injury.

• Respiratory failure in neurosurgical patients may occur secondary to intra- and extracranial complications.

• Neurogenic pulmonary edema is caused by an increase in sympathetic activity secondary to a combination of factors.

• Comatose patients and those with bulbar palsies require careful respiratory management and airway protection.

• Therapeutic hyperventilation is an important tool in the acute management of intracranial hypertension but its use over several days has never been shown to improve outcome.

• Overzealous hyperventilation may precipitate cerebral ischemia secondary to cerebral vasoconstriction.

• Cerebral perfusion pressure must be maintained during intensive respiratory support of neurosurgical patients by adjustment of posture and level of positive end-expiratory pressure and by cardiovascular support.

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