[Efficacy of respiratory therapy/controlled hyperventilation in cerebral trauma].
In a prospective study in 129 patients with isolated head injury the efficacy of respiratory treatment/controlled moderate hyperventilation on the neurological outcome is to be tested. Indications for mechanical ventilation are either a bad neurological behaviour (GCS less than or equal to 5) or neurogenic-induced disturbances of pulmonary gas exchange. Both oxygenation and neurological behaviour are worse in the ventilated group than in patients breathing spontaneously. Therefore a direct and quantitative comparison between these two groups of patients is not possible; however, conclusions can be drawn on the efficacy of the respiratory management. Survival rate of all patients on discharge from ICU amounts to 61.2%; of the patients breathing spontaneously 96.1% survive the cerebral trauma, while only 39.7% of the ventilated patients survive. The post-traumatic course of the GCS-values shows a transient but statistically and clinically significant decrease for the nonventilated survivors, while a continuous increase can be demonstrated for the patients being ventilated and surviving the cerebral trauma (n = 31). The survival rate for the most severely injured and ventilated group (n =59; GCS less than or equal to 5) amounts to 38.9% (23/59 patients). Out of these 23 patients with initial extensor spasm 15 reach greater than or equal to 10 points on GCS-scale (12.2 +/- 0.5 P.) on discharge from ICU. An additional neurogenic-initiated respiratory failure increases the rate of mortality to a statistically significant extent (P less than 0.025). It is concluded that respiratory treatment with moderate hyperventilation positively influences the quality of the neurological outcome in patients with severe head injury.
D000328:Adult; D001930:Brain Injuries / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012138:Respiratory Therapy / Q000379:methods*
Die qualitative Wirkung der Beatmungstherapie/kontrollierten Hyperventilation beim cerebralen Trauma.