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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: Schurr@surgery.wisc.edu
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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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