A young man sustained traumatic lung, head and abdominal injuries. Despite mechanical ventilation, deteriorating respiratory function resulted in severe hypoxia and hypercapnia, with high P(a)co(2) compounding an already raised intracranial pressure (ICP). The Novalung was pre-emptively used without anticoagulation, prior to laparotomy, to remove carbon dioxide and to allow for cerebral and lung protective strategies. This facilitated control of ICP thereby limited possible secondary brain injury.