The impact of prehospital ventilation on outcome after severe traumatic brain injury

Keir J. Warner, Joseph Cuschieri, Michael K. Copass, Gregory Jurkovich, Eileen M. Bulger

Research output: Contribution to journalArticle

86 Citations (Scopus)

Abstract

BACKGROUND: Prehospital intubation has been challenged on the grounds that it predisposes to hyperventilation, which is detrimental after traumatic brain injury (TBI), and impairs venous return in patients with hypovolemia. We sought to determine the incidence of hyperventilation among a cohort of trauma patients undergoing prehospital intubation and the impact of ventilation on outcome after severe TBI. METHODS: Data were prospectively collected for all intubated trauma patients transported directly from the field for a period of 14 months (n = 574). An arrival Pco2 <30 mm Hg was termed severe hypocapnea and considered a marker of hyperventilation. Patients with a Pco2 >45 mm Hg were considered severely hypercapneic. Targeted ventilation was defined as a Pco2 between 30 and 35 mm Hg based on the Brain Trauma Foundation guidelines. RESULTS: The rate of severe hypocapnea was 18% and women were more likely to be hyperventilated (p < 0.05). Patients with severe hypercapnia had higher Injury Severity Scores and were more likely hypotensive, hypoxic, and acidodic (p < 0.05). Patients in the targeted ventilation range were less likely to die than were those outside the range even after excluding the severe hypercapnea group (odds ratio, 0.57; 95% confidence interval, 0.33-0.99). This effect was even greater among patients with isolated TBI (odds ratio, 0.31; 95% confidence interval, 0.10-0.96). CONCLUSION: Targeted prehospital ventilation is associated with lower mortality after severe TBI.

Original languageEnglish (US)
Pages (from-to)1330-1336
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume62
Issue number6
DOIs
StatePublished - Jun 1 2007
Externally publishedYes

Fingerprint

Ventilation
Hyperventilation
Intubation
Odds Ratio
Confidence Intervals
Hypovolemia
Injury Severity Score
Hypercapnia
Wounds and Injuries
Traumatic Brain Injury
Guidelines
Mortality
Incidence

Keywords

  • Hyperventilation
  • Intubation
  • Outcome
  • Prehospital
  • Target ventilation
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery

Cite this

The impact of prehospital ventilation on outcome after severe traumatic brain injury. / Warner, Keir J.; Cuschieri, Joseph; Copass, Michael K.; Jurkovich, Gregory; Bulger, Eileen M.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 62, No. 6, 01.06.2007, p. 1330-1336.

Research output: Contribution to journalArticle

Warner, Keir J. ; Cuschieri, Joseph ; Copass, Michael K. ; Jurkovich, Gregory ; Bulger, Eileen M. / The impact of prehospital ventilation on outcome after severe traumatic brain injury. In: Journal of Trauma - Injury, Infection and Critical Care. 2007 ; Vol. 62, No. 6. pp. 1330-1336.
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