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delivery exceeds metabolic requirements by a factor of two to three, there is a considerable reserve in place before available O 2 is reduced below the minimum needed to maintain cerebral metabolism. It is only when available O 2 falls below this minimum level that the brain can no longer produce sufficient high-energy phosphate molecules to maintain its functions (energy failure). Energy failure must occur before ischemic damage is possible. Thus, the question that needs to be addressed is whether hyperventilation in patients with TBI reduces CBF to the point of