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Prehospital hyperventilation after brain injury: a prospective analysis of prehospital and early hospital hyperventilation of the brain-injured patient. Prehosp Disaster Med 2003;18(1):20-3

Date

12/26/2003

Pubmed ID

14694896

DOI

10.1017/s1049023x00000637

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 herniation 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.

Author List

Lal D, Weiland S, Newton M, Flaten A, Schurr M

Author

Dave Lal MD, MPH Chief, Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Brain Injuries
Cause of Death
Craniotomy
Emergency Medical Services
Emergency Service, Hospital
Emergency Treatment
Female
Glasgow Coma Scale
Hospitalization
Humans
Hyperventilation
Injury Severity Score
Intracranial Pressure
Male
Middle Aged
Prevalence
Probability
Prospective Studies
Pulmonary Gas Exchange
Reference Values
Risk Assessment
Sampling Studies
Statistics, Nonparametric
Survival Analysis