Early ventilation and outcome in patients with moderate to severe traumatic brain injury*
- 1 April 2006
- journal article
- editorial
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 34 (4), 1202-1208
- https://doi.org/10.1097/01.ccm.0000208359.74623.1c
Abstract
An increase in mortality has been reported with early intubation in severe traumatic brain injury, possibly due to suboptimal ventilation. This analysis explores the impact of early ventilation on outcome in moderate to severe traumatic brain injury. Retrospective, registry-based analysis. This study was conducted in a large county trauma system that includes urban, suburban, and rural jurisdictions. Nonarrest trauma victims with a Head Abbreviated Injury Score of > or =3 were identified from our county trauma registry. Intubated patients were stratified into 5 mm Hg arrival PCO(2) increments. Logistic regression was used to calculate odds ratios for each increment, adjusting for age, gender, mechanism of injury, year of injury, preadmission Glasgow Coma Scale score, hypotension, Head Abbreviated Injury Score, Injury Severity Score, PO(2), and base deficit. Increments with the highest relative survival were used to define the optimal PCO(2) range. Outcomes for patients with arrival PCO(2) values inside and outside this optimal range were then explored for both intubated and nonintubated patients, adjusting for the same factors as defined previously. In addition, the independent outcome effect of hyperventilation and hypoventilation was assessed. A total of 890 intubated and 2,914 nonintubated patients were included. Improved survival was observed for the arrival PCO(2) range 30-49 mm Hg. Patients with arrival PCO(2) values inside this optimal range had improved survival and a higher incidence of good outcomes. Conversely, there was no improvement in outcomes for patients within this optimal PCO(2) range for nonintubated patients after adjusting for all of the factors defined previously. Both hyperventilation and hypoventilation were associated with worse outcomes in intubated but not nonintubated patients. The proportion of arrival PCO(2) values within the optimal range was lower for intubated vs. nonintubated patients. Arrival hypercapnia and hypocapnia are common and associated with worse outcomes in intubated but not spontaneously breathing patients with traumatic brain injury.Keywords
This publication has 70 references indexed in Scilit:
- A Follow-Up Analysis of Factors Associated with Head-Injury Mortality After Paramedic Rapid Sequence IntubationThe Journal of Trauma and Acute Care Surgery, 2005
- Endotracheal Intubation in the Field Does Not Improve Outcome in Trauma Patients Who Present without an Acutely Lethal Traumatic Brain InjuryThe Journal of Trauma and Acute Care Surgery, 2003
- Prehospital Intubation in Patients with Severe Head InjuryThe Journal of Trauma and Acute Care Surgery, 2000
- Rapid sequence intubation in the field versus hospital in trauma patientsThe Journal of Emergency Medicine, 2000
- Rapid sequence induction for intubation by an aeromedical transport team: A critical analysisThe American Journal of Emergency Medicine, 1998
- Early hypotension worsens neurological outcome in pediatric patients with moderately severe head traumaJournal of Pediatric Surgery, 1998
- Field intubation of trauma patients: Complications, indications, and outcomesThe American Journal of Emergency Medicine, 1996
- Hypoxemia and Arterial Hypotension at the Accident Scene in Head InjuryThe Journal of Trauma and Acute Care Surgery, 1996
- The effect of hypotension and hypoxia on children with severe head injuriesJournal of Pediatric Surgery, 1993
- THE ROLE OF SECONDARY BRAIN INJURY IN DETERMINING OUTCOME FROM SEVERE HEAD INJURYThe Journal of Trauma and Acute Care Surgery, 1993