title: Prehospital hyperventilation after brain injury: a prospective analysis of prehospital and early hospital hyperventilation of the brain-injured patient.
abstract: 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.
authors.affiliation: Department of Surgery, Medical School, University of Wisconsin, Madison, Wisconsin 53792, USA.
authors.forename: Dave
authors.initials: D
authors.lastname: Lal
authors.forename: Steve
authors.initials: S
authors.lastname: Weiland
authors.forename: Monica
authors.initials: M
authors.lastname: Newton
authors.forename: Anne
authors.initials: A
authors.lastname: Flaten
authors.forename: Michael
authors.initials: M
authors.lastname: Schurr
mesh_terms: 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