title: A survey of routine treatment of patients with intracranial hypertension (ICH) in specialized trauma centers in Sao Paulo, Brazil: a 11 million metropole!
abstract: OBJECTIVE
  A survey of intensive care units (ICU) in São Paulo that care for patients with TBI and ICH using the hyperventilation technique.
  
  
  METHODS
  A questionnaire was given to the physiotherapist coordinator at 57 hospitals in São Paulo, where 24-h neurosurgery service is provided.
  
  
  RESULTS
  Fifty-one (89.5%) hospitals replied. From this total, thirty-four (66.7% perform the hyperventilation technique, 30 (85%) had the objective to reach values below 35 mmHg, four (11%) levels between 35 mmHg and 40 mmHg and one (3%) values over 40 mmHg.
  
  
  CONCLUSIONS
  We concluded that most hospitals in São Paulo perform hyperventilation in patients with severe brain trauma although there are not any specific Brazilian guidelines on this topic. Widespread controversy on the use of the hyperventilation technique in patients with severe brain trauma highlights the need for a specific Global policy on this topic.
authors.affiliation: Research fellow of the Neurosurgery Physiotherapy Research Group of the Respiratory Division at Escola Paulista de Medicina at Federal University of São Paulo (Unifesp/EPM), Rua dos Açores, 310, 1° andar, São Paulo 04032-010, Brazil. Electronic address: mabatan23@yahoo.com.br.
authors.forename: Marcela B
authors.initials: MB
authors.lastname: Alith
authors.affiliation: Physiotherapy Department at Unifesp/EPM, Rua dos Açores, 310, 1° andar, São Paulo 04032-010, Brazil.
authors.forename: Milena C
authors.initials: MC
authors.lastname: Vidotto
authors.affiliation: Respiratory Division at EPM, Director of the Pulmonary Rehabilitation Center at Unifesp/EPM, São Paulo, Brazil. Electronic address: jardimpneumo@gmail.com.
authors.forename: José R
authors.initials: JR
authors.lastname: Jardim
authors.affiliation: Coordinator of the Neurosurgery Physiotherapy Research Group of the Respiratory Division at Unifesp/EPM, Rua dos Açores, 310. 1° andar, São Paulo 04032-010, Brazil. Electronic address: marigazzotti@hotmail.com.
authors.forename: Mariana R
authors.initials: MR
authors.lastname: Gazzotti
mesh_terms: D001930:Brain Injuries / Q000628:therapy*; D001938:Brazil; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D019586:Intracranial Hypertension / Q000628:therapy*; D019635:Neurosurgical Procedures / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards; D011795:Surveys and Questionnaires; D014193:Trauma Centers / Q000706:statistics & numerical data*
keywords: Hyperventilation; Intensive care units; Intracranial hypertension; Neurosurgery