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Prehospital Hyperventilation After Brain Injury: A Prospective Analysis of Prehospital and Early Hospital Hyperventilation of the Brain-Injured Patient

Published online by Cambridge University Press:  28 June 2012

Dave Lal ,
Steve Weiland ,
Monica Newton ,
Anne Flaten  and
Michael Schurr
Dave Lal
Affiliation:
Department of Surgery, Medical School, University of Wisconsin, Madison, Wisconsin
Steve Weiland
Affiliation:
Department of Surgery, Medical School, University of Wisconsin, Madison, Wisconsin
Monica Newton
Affiliation:
Department of Surgery, Medical School, University of Wisconsin, Madison, Wisconsin
Anne Flaten
Affiliation:
Department of Surgery, Medical School, University of Wisconsin, Madison, Wisconsin
Michael Schurr*
Affiliation:
Department of Surgery, Medical School, University of Wisconsin, Madison, Wisconsin
*
Department of Surgery, University of Wisconsin-Madison, 600 Highland Avenue, Madison, Wisconsin 53792 USA, E-mail: [email protected]
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Abstract

Background:

The Brain Trauma Foundation's Guidelines for the Management of Severe Head Injury state that the use of prophylactic hyperventilation after traumatic brain injury (TBI) should be avoided because it can compromise cerebral perfusion. The objective of this study was to assess the prevalence of unintentional hyperventilation.

Methods:

A prospective evaluation of all intubated trauma patients with a diagnosis of TBI was performed. Patients with signs of impending hernia-tion were excluded.

Results:

Forty patients were included in the study. The average Glasgow Coma Scale (GCS) was 6.3. Of these, 28 patients (70%) were unintentionally hyperventilated. Eleven (39%) of the hyperventilated patients died or were discharged in a persistent vegetative state. Of the remaining 12 patients who experienced normal ventilation, three patients (25%) died or were discharged in a vegetative state (p = ns) (Table 1).

Conclusion:

Hyperventilation was common after TBI. However, patients ventilated to a normal PaCO2 were significantly more acidotic. Prehospital personnel should undergo educational training after development of strict ventilation protocols for patients suffering TBI.

Keywords

acidosisbrain injurycarbon dioxide levelhyperventilationintracranial pressuretrauma
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 18 , Issue 1 , March 2003 , pp. 20 - 23
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2003

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References

1.Miller, JD, Becker, DP, Ward, JD, Sullivan, HG, Adams, WE, Rosner, MJ: Significance of intracranial hypertension in severe head injury. J Neurosurg 1977; 47(4): 503–516.CrossRefGoogle ScholarPubMed
2.Bullock, MR, Randall, MC, Guy, LC, et al: The use of hyperventilation in the acute management of severe traumatic brain injury. Guidelines for the Management of Severe Head Injury. New York, NY: Brain Trauma Foundation, 1995.Google Scholar
3.Braman, SS, Dunn, SM, Amico, CA, Millman, RP: Complications of intrahospital transport in critically ill patients. Ann Intern Med 1987; 107(4): 469–473.CrossRefGoogle ScholarPubMed
4.Tobias, JD, Lynch, A, Garrett, J: Alterations of end-tidal carbon dioxide during the intrahospital transport of children. Pediatr Emerg Care 1996; 12: 249–251.CrossRefGoogle ScholarPubMed
5.Davey, AL, Macnab, AJ, Green, G: Changes in pCO2 during air medical transport of children with closed head injuries. Air Med J 2001; 20(4): 27–30.CrossRefGoogle ScholarPubMed
6.Wolff, HG: The cerebral circulation. Physiological Reviews 1936; 16: 545–596.CrossRefGoogle Scholar
7.Lundberg, N, Kjallquist, A, Bien, C: Reduction of increased intracranial pressure by hyperventilation: A therapeutic aid in neurological surgery. Acta Psychiatrica et Neurologica Scandinavica 1959; 34(suppl 139): 1–64.Google ScholarPubMed
8.Crockard, HA, Coppel, DL, Morrow, WF: Evaluation of hyperventilation in treatment of head injuries. Br Med J 1973; 4: 634–640.CrossRefGoogle ScholarPubMed
9.Paul, RL, Polanco, O, Turney, SZ, McAslan, TC, Cowley, RA: Intracranial pressure responses to alterations in arterial carbon dioxide pressure in patients with head injuries. J Neurosurg 1972; 36: 714–720.CrossRefGoogle ScholarPubMed
10.Raichle, ME, Plum, F: Hyperventilation and cerebral blood flow. Stroke 1972; 3: 566–575.CrossRefGoogle ScholarPubMed
11.Muizelaar, JP, Marmarou, A, Ward, JD, et al: Adverse effects of prolonged hyperventilation in patients with severe head injury: A randominized clinical trial. J Neurosurg 1991; 75: 731–739.CrossRefGoogle ScholarPubMed
12.Marion, DW, Bouma, GJ: The use of stable xenon-enhanced computed tomographic studies of cerebral blood flow to define changes in cerebral carbon dioxide vasoresponsivity caused by a severe head injury. Neurosurgery 1991; 29: 869–873.CrossRefGoogle ScholarPubMed
13.Unterberg, AW, Kiening, KL, Hartl, R, Bardt, T, Sarrafzadeh, AS, Lanksch, WR: Multimodal monitoring in patients with head injury: Evaluation of the effects of treatment on cerebral oxygenation. J Trauma 1997; 42(5): S32–S37.CrossRefGoogle ScholarPubMed
14.Yokota, H, Yamamoto, Y, Naoe, Y, et al. Measurements of cortical cellular pH by intracranial tonometer in severe head injury. Crit Care Med 2000; 28(9): 3275–3280.CrossRefGoogle ScholarPubMed
15.Carmona Suazo, JA, Maas, AI, van den Brink, WA, van Santbrink, H, Steyerberg, EW, Avezaat, CJ: CO2 reactivity and brain oxygen pressure monitoring in severe head injury. Crit Care Med 2000; 28(9): 3268–3274.CrossRefGoogle ScholarPubMed
16.Van den Brink, WA, Van Santbrink, H, Steyerberg, EW, et al: Brain oxygen tension in severe head injury. Neurosurgery 2000; 46(4): 868–876.Google ScholarPubMed
17.Manley, GT, Hemphill, JC, Morabito, D, et al: Cerebral oxygenation during hemorrhagic shock: perils of hyperventilation and the therapeutic potential of hypoventilation. J Trauma 2000; 48(6): 1025–1032.CrossRefGoogle ScholarPubMed
18. American College of Surgeons National Trauma Data Bank. 2002.Google Scholar
19.Kerr, M, Zempsky, J, Sereika, S, Orndoff, P, Rudy, EB: Relationship between arterial carbon dioxide and end-tidal carbon dioxide in mechanically ventilated adults with severe head trauma. Crit Care Med 1996; 24(5): 785–790.CrossRefGoogle ScholarPubMed
20.Bhende, MS, LaCovey, DC: End-tidal carbon dioxide monitoring in the prehospital setting. Prehosp Emerg Care 2001; 5(2): 208–213.CrossRefGoogle ScholarPubMed