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, the resulting data pertain only to the global effects of hyperventilation. Cruz's conclusions and implicit recommendations for the treatment of severe TBI could be adopted safely only if cerebral metabolism and blood flow were regionally homogeneous after a TBI and if unilateral jugular venous samples were reliably representative of global metabolites. However, most studies of cerebral blood flow (CBF) and metabolism indicate that there are significant regional differences in both. 2, 4, 5 Local variations in CBF are particularly common surrounding contusions or

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, without providing information on regional cerebral metabolism (regional cerebral oxygen consumption or regional cerebral extraction of oxygen). Changes in PaCO 2 were intentionally induced (without clinical indication) in a wide range from 24 to 32 mm Hg, which the authors referred to as “mild hyperventilation.” In contrast, in a recent paper from the same group 7 PaCO 2 levels below 29 mm Hg were regarded as “extreme hyperventilation.” Stable Xe—computerized tomography (CT) rCBF studies lack crucial information regarding comatose patients with acutely injured