Workaround: random game crashes and drops to desktop
I own an 8800GT 256MB video card, and noticed in playing Left 4 Dead I would get random BSOD or drops to the desktop. In L4D, there's a setting to change how much memory is allocated for video use: low/medium/high; setting this to low worked for me, with all other detail settings unchanged. However, this game doesn't have that, and I've had similar issues. So what I've done is tried to find video settings that don't crash on me: 1280x1024 with medium detail works.
Of course, you need the latest video drivers and a good platform: I'm using x64 Windows 7 with the latest GeForce drivers from Guru3D.
A permanent fix would be for the developers to anticipate how much video ram might be used for settings and lockout settings that won't remain stable.