Altitude-specific neurocritical care: A case study in the management of traumatic brain injury

• Autores: Maldonado-Coronel, Fausto, Castillo-Caicedo, Catty, Viruez-Soto, Antonio, Huanca-Payehuanca, Roger, Tinoco-Solórzano, Amílcar, Molano-Franco, Daniel, Arias-Reyes, Christian, Soliz, Jorge
• Formato: artículo
• Fecha de Publicación: 2025
• Institución: Seguro Social de Salud
• Repositorio: ESSALUD-Institucional
• Lenguaje: inglés
• OAI Identifier: oai:repositorio.essalud.gob.pe:20.500.12959/5775
• Enlace del recurso: https://hdl.handle.net/20.500.12959/5775; https://doi.org/10.1016/j.hmedic.2025.100385
• Nivel de acceso: acceso abierto
• Materia: Neurocritical care; High-altitude medicine; Hypoxia; Cerebral perfusion; Hyperemia; Altitude-specific protocols; https://purl.org/pe-repo/ocde/ford#3.02.25

Introduction: This case illustrates a unique challenge in neurocritical care at high altitude, where sea-level ventilation protocols can be detrimental. It adds novel clinical evidence by showing the pathophysiological consequences and therapeutic reversal of hypercapnia-induced cerebral hyperemia in a high-altitude native with traumatic brain injury (TBI). Main symptoms and findings: A 25-year-old man, lifelong resident at 3600 m above sea level (m.a.s.l.), presented with moderate-to-severe TBI following a motor vehicle accident. He exhibited cerebral edema and hemorrhagic contusions on CT, with transcranial Doppler indicating cerebral hyperemia. Diagnosis, intervention, and outcomes: Initial ventilation based on sea-level PaCO₂ norms led to iatrogenic hypercapnia and cerebral hyperemia. Upon adjusting the ventilatory targets to an altitude-appropriate PaCO₂ range (26–28 mmHg), cerebral blood flow normalized, as confirmed by Doppler. The patient rapidly recovered and was discharged neurologically intact. Conclusion: In high-altitude settings, standard ventilation protocols may provoke secondary cerebral complications. This case highlights the critical importance of individualized, altitude-specific neurocritical strategies, with transcranial Doppler serving as a valuable bedside guide to optimize outcomes in altitude-acclimatized TBI patients.