Prehospital hyperventilation after brain injury: a prospective analysis of prehospital and early hospital hyperventilation of the brain-injured patient.
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 herniation 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).


CONCLUSIONS
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.
Lal
Dave
D
Department of Surgery, Medical School, University of Wisconsin, Madison, Wisconsin 53792, USA.
Weiland
Steve
S
Newton
Monica
M
Flaten
Anne
A
Schurr
Michael
M
D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D002423:Cause of Death; D003399:Craniotomy; D004632:Emergency Medical Services / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards*; D004638:Emergency Treatment / Q000379:methods* / Q000592:standards; D005260:Female; D015600:Glasgow Coma Scale; D006760:Hospitalization; D006801:Humans; D006985:Hyperventilation / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D015601:Injury Severity Score; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011336:Probability; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange; D012016:Reference Values; D018570:Risk Assessment; D012494:Sampling Studies; D018709:Statistics, Nonparametric; D016019:Survival Analysis