title: Admission oxygenation and ventilation parameters associated with discharge survival in severe pediatric traumatic brain injury.
abstract: OBJECTIVE
  Current Brain Trauma Foundation guidelines recommend avoiding hypoxemia after severe pediatric traumatic brain injury (TBI). Yet, recent studies on optimum admission oxygenation and ventilation parameters associated with discharge survival in pediatric TBI are lacking.
  
  
  METHODS
  After IRB approval, a retrospective study involving pediatric patients ages ≤14 years with severe TBI (head Abbreviated Injury Scale (AIS) score of ≥3, Glasgow Coma Scale score of ≤8 on admission) admitted to Harborview Medical Center (level 1 pediatric trauma center), Seattle, WA, during 2003 to 2007 was performed. Admission demographics, clinical data, and laboratory characteristics were abstracted. Hypoxemia was defined as PaO2 < 60 mmHg, hypocarbia was defined as PaCO2 ≤ 35 mmHg, and hypercarbia was defined as PaCO2 ≥ 46 mmHg.
  
  
  RESULTS
  One hundred ninety-four patients met inclusion criteria of which 162 (83.5 %) patients survived. Admission hypoxemia occurred in nine (5.6 %) patients who survived and eight (25 %) patients who died (p < 0.001). Children with admission PaCO2 between 36 and 45 mmHg had greater discharge survival compared with those with both admission hypocarbia (PaCO2 ≤ 35 mmHg) and hypercarbia (PaCO2 ≥ 46 mmHg). Admission PaO2 301-500 mmHg (adjusted odds ratio (AOR), 8.02 (95 % confidence interval (CI), 1.73-37.10); p = 0.008) and admission PaCO2 = 36-45 mmHg (AOR, 5.47 (95 % CI, 1.30-23.07); p = 0.02) were independently associated with discharge survival.
  
  
  CONCLUSIONS
  Discharge survival after severe pediatric TBI was associated with admission PaO2 301-500 mmHg and PaCO2 = 36-45 mmHg. Admission hypocarbia and hypercarbia were each associated with increased discharge mortality.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Harborview Medical Center, 325 Ninth Avenue, PO Box 359724, Seattle, WA 98104, USA.
authors.forename: Vijay Kumar
authors.initials: VK
authors.lastname: Ramaiah
authors.forename: Deepak
authors.initials: D
authors.lastname: Sharma
authors.forename: Li
authors.initials: L
authors.lastname: Ma
authors.forename: Sumidtra
authors.initials: S
authors.lastname: Prathep
authors.forename: Noah G
authors.initials: NG
authors.lastname: Hoffman
authors.forename: Monica S
authors.initials: MS
authors.lastname: Vavilala
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000150:complications / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D006400:Hematocrit; D006760:Hospitalization; D006801:Humans; D006935:Hypercapnia / Q000150:complications / Q000401:mortality; D016857:Hypocapnia / Q000150:complications / Q000401:mortality; D000860:Hypoxia / Q000150:complications / Q000401:mortality*; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D010351:Patient Discharge; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome