Prehospital Hyperventilation After Brain Injury: A Prospective Analysis of Prehospital and Early Hospital Hyperventilation of the Brain-Injured Patient
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 un...
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| Veröffentlicht in: | Prehospital and disaster medicine 2003, Vol.18 (1), p.20-23 |
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| creator | Lal, Dave Weiland, Steve Newton, Monica Flaten, Anne Schurr, Michael |
| description | 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.
A prospective evaluation of all intubated trauma patients with a diagnosis of TBI was performed. Patients with signs of impending herniation were excluded.
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).
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. |
| doi_str_mv | 10.1017/S1049023X00000637 |
| format | Article |
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A prospective evaluation of all intubated trauma patients with a diagnosis of TBI was performed. Patients with signs of impending herniation were excluded.
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).
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.</description><identifier>ISSN: 1049-023X</identifier><identifier>EISSN: 1945-1938</identifier><identifier>DOI: 10.1017/S1049023X00000637</identifier><identifier>PMID: 14694896</identifier><language>eng</language><publisher>New York, USA: Cambridge University Press</publisher><subject>acidosis ; Adult ; Brain Injuries - complications ; Brain Injuries - diagnosis ; Brain Injuries - surgery ; brain injury ; carbon dioxide level ; Cause of Death ; Craniotomy ; Emergency Medical Services - standards ; Emergency Service, Hospital - standards ; Emergency Treatment - methods ; Emergency Treatment - standards ; Female ; Glasgow Coma Scale ; Health technology assessment ; Hospitalization ; Humans ; hyperventilation ; Hyperventilation - diagnosis ; Hyperventilation - epidemiology ; Hyperventilation - therapy ; Injury Severity Score ; Intracranial Pressure ; Male ; Middle Aged ; Original Research ; Prevalence ; Probability ; Prospective Studies ; Pulmonary Gas Exchange ; Reference Values ; Risk Assessment ; Sampling Studies ; Statistics, Nonparametric ; Survival Analysis ; trauma</subject><ispartof>Prehospital and disaster medicine, 2003, Vol.18 (1), p.20-23</ispartof><rights>Copyright © World Association for Disaster and Emergency Medicine 2003</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c296t-30e3af7e0889bb08a165c0eb9c7f9ba041ad645edf24752b5768661ce1d3d1493</citedby><cites>FETCH-LOGICAL-c296t-30e3af7e0889bb08a165c0eb9c7f9ba041ad645edf24752b5768661ce1d3d1493</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.cambridge.org/core/product/identifier/S1049023X00000637/type/journal_article$$EHTML$$P50$$Gcambridge$$H</linktohtml><link.rule.ids>164,314,780,784,4024,27923,27924,27925,55628</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/14694896$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lal, Dave</creatorcontrib><creatorcontrib>Weiland, Steve</creatorcontrib><creatorcontrib>Newton, Monica</creatorcontrib><creatorcontrib>Flaten, Anne</creatorcontrib><creatorcontrib>Schurr, Michael</creatorcontrib><title>Prehospital Hyperventilation After Brain Injury: A Prospective Analysis of Prehospital and Early Hospital Hyperventilation of the Brain-Injured Patient</title><title>Prehospital and disaster medicine</title><addtitle>Prehosp. Disaster med</addtitle><description>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.
A prospective evaluation of all intubated trauma patients with a diagnosis of TBI was performed. Patients with signs of impending herniation were excluded.
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).
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.</description><subject>acidosis</subject><subject>Adult</subject><subject>Brain Injuries - complications</subject><subject>Brain Injuries - diagnosis</subject><subject>Brain Injuries - surgery</subject><subject>brain injury</subject><subject>carbon dioxide level</subject><subject>Cause of Death</subject><subject>Craniotomy</subject><subject>Emergency Medical Services - standards</subject><subject>Emergency Service, Hospital - standards</subject><subject>Emergency Treatment - methods</subject><subject>Emergency Treatment - standards</subject><subject>Female</subject><subject>Glasgow Coma Scale</subject><subject>Health technology assessment</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>hyperventilation</subject><subject>Hyperventilation - diagnosis</subject><subject>Hyperventilation - epidemiology</subject><subject>Hyperventilation - therapy</subject><subject>Injury Severity Score</subject><subject>Intracranial Pressure</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Original Research</subject><subject>Prevalence</subject><subject>Probability</subject><subject>Prospective Studies</subject><subject>Pulmonary Gas Exchange</subject><subject>Reference Values</subject><subject>Risk Assessment</subject><subject>Sampling Studies</subject><subject>Statistics, Nonparametric</subject><subject>Survival Analysis</subject><subject>trauma</subject><issn>1049-023X</issn><issn>1945-1938</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kVFP2zAUha1paC2wH7CXyU97C9ixY8d7axFQEBJFgMSb5SQ3q7s06WwHLb-Ev4tLKzYJgV9s6Zzz6VxfhL5RckQJlce3lHBFUvZANkcw-QmNqeJZQhXLP8d3lJONPkL73i8JSVWWii9oRLlQPFdijJ7mDhadX9tgGjwb1uAeoQ22McF2LZ7UARyeOmNbfNEuezf8xBM8dzEAZbCPgCetaQZvPe5q_D_KtBU-Na4Z8OxdeoyEBWzxyQseKjyPWvQcor3aNB6-7u4DdH92encyS66uzy9OJldJmSoREkaAmVoCyXNVFCQ3VGQlgUKVslaFIZyaSvAMqjrlMkuLTIpcCFoCrVhFuWIH6MeWu3bdnx580CvrS2ga00LXey0pzwUhPBrp1ljG6b2DWq-dXRk3aEr0Zhv6zTZi5vsO3hcrqP4ldt8fDcnWYH2Av6-6cb-1kExmWpzf6EuesfT2bKo3JdiuhFkVzla_QC-73sUd-A9qPANvaqZK</recordid><startdate>2003</startdate><enddate>2003</enddate><creator>Lal, Dave</creator><creator>Weiland, Steve</creator><creator>Newton, Monica</creator><creator>Flaten, Anne</creator><creator>Schurr, Michael</creator><general>Cambridge University Press</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>2003</creationdate><title>Prehospital Hyperventilation After Brain Injury: A Prospective Analysis of Prehospital and Early Hospital Hyperventilation of the Brain-Injured Patient</title><author>Lal, Dave ; Weiland, Steve ; Newton, Monica ; Flaten, Anne ; Schurr, Michael</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c296t-30e3af7e0889bb08a165c0eb9c7f9ba041ad645edf24752b5768661ce1d3d1493</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>acidosis</topic><topic>Adult</topic><topic>Brain Injuries - complications</topic><topic>Brain Injuries - diagnosis</topic><topic>Brain Injuries - surgery</topic><topic>brain injury</topic><topic>carbon dioxide level</topic><topic>Cause of Death</topic><topic>Craniotomy</topic><topic>Emergency Medical Services - standards</topic><topic>Emergency Service, Hospital - standards</topic><topic>Emergency Treatment - methods</topic><topic>Emergency Treatment - standards</topic><topic>Female</topic><topic>Glasgow Coma Scale</topic><topic>Health technology assessment</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>hyperventilation</topic><topic>Hyperventilation - diagnosis</topic><topic>Hyperventilation - epidemiology</topic><topic>Hyperventilation - therapy</topic><topic>Injury Severity Score</topic><topic>Intracranial Pressure</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Original Research</topic><topic>Prevalence</topic><topic>Probability</topic><topic>Prospective Studies</topic><topic>Pulmonary Gas Exchange</topic><topic>Reference Values</topic><topic>Risk Assessment</topic><topic>Sampling Studies</topic><topic>Statistics, Nonparametric</topic><topic>Survival Analysis</topic><topic>trauma</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lal, Dave</creatorcontrib><creatorcontrib>Weiland, Steve</creatorcontrib><creatorcontrib>Newton, Monica</creatorcontrib><creatorcontrib>Flaten, Anne</creatorcontrib><creatorcontrib>Schurr, Michael</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Prehospital and disaster medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lal, Dave</au><au>Weiland, Steve</au><au>Newton, Monica</au><au>Flaten, Anne</au><au>Schurr, Michael</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prehospital Hyperventilation After Brain Injury: A Prospective Analysis of Prehospital and Early Hospital Hyperventilation of the Brain-Injured Patient</atitle><jtitle>Prehospital and disaster medicine</jtitle><addtitle>Prehosp. Disaster med</addtitle><date>2003</date><risdate>2003</risdate><volume>18</volume><issue>1</issue><spage>20</spage><epage>23</epage><pages>20-23</pages><issn>1049-023X</issn><eissn>1945-1938</eissn><abstract>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.
A prospective evaluation of all intubated trauma patients with a diagnosis of TBI was performed. Patients with signs of impending herniation were excluded.
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).
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.</abstract><cop>New York, USA</cop><pub>Cambridge University Press</pub><pmid>14694896</pmid><doi>10.1017/S1049023X00000637</doi><tpages>4</tpages></addata></record> |
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| source | MEDLINE; Cambridge University Press Journals Complete |
| subjects | acidosis Adult Brain Injuries - complications Brain Injuries - diagnosis Brain Injuries - surgery brain injury carbon dioxide level Cause of Death Craniotomy Emergency Medical Services - standards Emergency Service, Hospital - standards Emergency Treatment - methods Emergency Treatment - standards Female Glasgow Coma Scale Health technology assessment Hospitalization Humans hyperventilation Hyperventilation - diagnosis Hyperventilation - epidemiology Hyperventilation - therapy Injury Severity Score Intracranial Pressure Male Middle Aged Original Research Prevalence Probability Prospective Studies Pulmonary Gas Exchange Reference Values Risk Assessment Sampling Studies Statistics, Nonparametric Survival Analysis trauma |
| title | Prehospital Hyperventilation After Brain Injury: A Prospective Analysis of Prehospital and Early Hospital Hyperventilation of the Brain-Injured Patient |
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