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The use of hyperventilation theraphy after traumatic brain injury in Europe: an analysis of the BrainIT database
(Brain IT Group)
(Brain IT Group)
(Brain-IT Group)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery. (Brain IT Group)
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2008 (English)In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 34, no 9, 1676-1682 p.Article in journal (Refereed) Published
Abstract [en]

Objective

To assess the use of hyperventilation and the adherence to Brain Trauma Foundation-Guidelines (BTF-G) after traumatic brain injury (TBI).

Setting

Twenty-two European centers are participating in the BrainIT initiative.

Design

Retrospective analysis of monitoring data.

Patients and participants

One hundred and fifty-one patients with a known time of trauma and at least one recorded arterial blood–gas (ABG) analysis.

Measurements and results

A total number of 7,703 ABGs, representing 2,269 ventilation episodes(VE) were included in the analysis. Related minute-by-minute ICP data were taken from a 30 min time window around each ABG collection. Data are given as mean with standard deviation. (1) Patients without elevated intracranial pressure (ICP) (\20 mmHg) manifested a statistically significant higher PaCO2(36 ± 5.7 mmHg) in comparison to patients with elevated ICP(C20 mmHg; PaCO2:34 ± 5.4 mmHg, P\0.001). (2) Intensified forced hyperventilation(PaCO2 B 25 mmHg) in the absence of elevated ICP was found in only 49VE (2%). (3) Early prophylactic hyperventilation (\24 h after TBI;PaCO2 B 35 mmHg,ICP\20 mmHg) was used in 1,224VE (54%). (4) During forced hyperventilation(PaCO2 B 30 mmHg), simultaneous monitoring of brain tissue pO2 or SjvO2 was used in only 204 VE (9%).

Conclusion

While overall adherence to current BTF-Gseems to be the rule, its recommendations on early prophylactic hyperventilation as well as the use of additional cerebral oxygenation monitoring during forced hyperventilation are not followed in this sample of European TBI centers.

Descriptor

Neurotrauma

Place, publisher, year, edition, pages
2008. Vol. 34, no 9, 1676-1682 p.
Keyword [en]
Traumatic brain injury, Hyperventilation
National Category
Surgery
Research subject
Neurosurgery
Identifiers
URN: urn:nbn:se:uu:diva-100187DOI: 10.1007/s00134-008-1123-7ISI: 000258562800019PubMedID: 18449528OAI: oai:DiVA.org:uu-100187DiVA: diva2:209700
Available from: 2009-03-26 Created: 2009-03-26 Last updated: 2017-12-13Bibliographically approved

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