title: Hyperventilation in traumatic brain injury patients: inconsistency between consensus guidelines and clinical practice.
abstract: BACKGROUND
  This study assessed patients with traumatic brain injury (TBI) to determine whether prehospital and community hospital providers employed hyperventilation therapy inconsistent with consensus recommendation against its routine use.
  
  
  METHODS
  This prospective analysis of 37 intubated TBI patients without herniation, undergoing helicopter transport to an urban Level I center, entailed flight crews' noting of assisted ventilation rate (AVR) and end-tidal carbon dioxide (ETCO2) upon their arrival at trauma scenes or community hospitals. A priori-set levels of AVR and ETCO2 were used to assess frequency of guideline-inconsistent hyperventilation, and Fisher's exact and Kruskal-Wallis tests assessed association between guideline-inconsistent hyperventilation and manual vs. mechanical ventilation mode.
  
  
  RESULTS
  Inappropriately high AVR and low ETCO2 were seen in 60% and 70% of patients, respectively. Manual ventilation was associated with guideline-inconsistent hyperventilation assessed by AVR (p = 0.038) and ETCO2 (p = 0.022).
  
  
  CONCLUSIONS
  Prehospital and community hospital hyperventilation practices are not consistent with consensus recommendations for limitation of hyperventilation therapy.
authors.affiliation: Boston MedFlight Critical Care Transport Service, Boston, Massachusetts, USA. thomas.stephen@mgh.harvard.edu
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Thomas
authors.forename: Janet
authors.initials: J
authors.lastname: Orf
authors.forename: Suzanne K
authors.initials: SK
authors.lastname: Wedel
authors.forename: Alasdair K
authors.initials: AK
authors.lastname: Conn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001927:Brain Diseases / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D001930:Brain Injuries / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D002245:Carbon Dioxide / Q000097:blood; D002560:Cerebrovascular Circulation / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D015600:Glasgow Coma Scale; D019983:Guideline Adherence / Q000592:standards*; D006764:Hospitals, Community / Q000592:standards*; D006801:Humans; D006985:Hyperventilation / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects / Q000592:standards
chemical_list: D002245:Carbon Dioxide