Hyperventilation in traumatic brain injury patients: inconsistency between consensus guidelines and clinical practice.
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.
Thomas
Stephen H
SH
Boston MedFlight Critical Care Transport Service, Boston, Massachusetts, USA. thomas.stephen@mgh.harvard.edu
Orf
Janet
J
Wedel
Suzanne K
SK
Conn
Alasdair K
AK
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
D002245:Carbon Dioxide