Intensive Care Medicine

, 34:1676

The use of hyperventilation therapy after traumatic brain injury in Europe: an analysis of the BrainIT database

  • J.-O. Neumann
  • I. R. Chambers
  • G. Citerio
  • P. Enblad
  • B. A. Gregson
  • T. Howells
  • J. Mattern
  • P. Nilsson
  • I. Piper
  • A. Ragauskas
  • J. Sahuquillo
  • Y. H. Yau
  • K. Kiening
  • on behalf of the BrainIT Group
Original

DOI: 10.1007/s00134-008-1123-7

Cite this article as:
Neumann, J., Chambers, I.R., Citerio, G. et al. Intensive Care Med (2008) 34: 1676. doi:10.1007/s00134-008-1123-7

Abstract

Objective

To assess the use of hyperventilation and the adherence to Brain Trauma Foundation-Guidelines (BTF-G) after traumatic brain injury (TBI).

Setting

Twenty-two European centers are participating in the BrainIT initiative.

Design

Retrospective analysis of monitoring data.

Patients and participants

One hundred and fifty-one patients with a known time of trauma and at least one recorded arterial blood–gas (ABG) analysis.

Measurements and results

A total number of 7,703 ABGs, representing 2,269 ventilation episodes (VE) were included in the analysis. Related minute-by-minute ICP data were taken from a 30 min time window around each ABG collection. Data are given as mean with standard deviation. (1) Patients without elevated intracranial pressure (ICP) (<20 mmHg) manifested a statistically significant higher PaCO2 (36 ± 5.7 mmHg) in comparison to patients with elevated ICP (≥20 mmHg; PaCO2: 34 ± 5.4 mmHg, P < 0.001). (2) Intensified forced hyperventilation (PaCO2 ≤ 25 mmHg) in the absence of elevated ICP was found in only 49 VE (2%). (3) Early prophylactic hyperventilation (<24 h after TBI; PaCO2 ≤ 35 mmHg, ICP < 20 mmHg) was used in 1,224 VE (54%). (4) During forced hyperventilation (PaCO2 ≤ 30 mmHg), simultaneous monitoring of brain tissue pO2 or SjvO2 was used in only 204 VE (9%).

Conclusion

While overall adherence to current BTF-G seems to be the rule, its recommendations on early prophylactic hyperventilation as well as the use of additional cerebral oxygenation monitoring during forced hyperventilation are not followed in this sample of European TBI centers.

Descriptor

Neurotrauma

Keywords

Traumatic brain injuryHyperventilation

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • J.-O. Neumann
    • 1
  • I. R. Chambers
    • 2
  • G. Citerio
    • 3
  • P. Enblad
    • 4
  • B. A. Gregson
    • 5
  • T. Howells
    • 4
  • J. Mattern
    • 1
  • P. Nilsson
    • 4
  • I. Piper
    • 6
  • A. Ragauskas
    • 7
  • J. Sahuquillo
    • 8
  • Y. H. Yau
    • 9
  • K. Kiening
    • 1
  • on behalf of the BrainIT Group
  1. 1.Department of NeurosurgeryUniversitätsklinikum HeidelbergHeidelbergGermany
  2. 2.Regional Medical Physics DepartmentJames Cook University HospitalMiddlesboroughUK
  3. 3.Department of Perioperative Medicine and Intensive CareNeuroICU, Hospital San GerardoMonzaItaly
  4. 4.Department of Clinical Neurosciences, Section of NeurosurgeryUppsala University HospitalUppsalaSweden
  5. 5.Department of NeurosurgeryNewcastle General HospitalNewcastle upon TyneUK
  6. 6.Department of Clinical PhysicsInstitute of Neurological Sciences, Southern General HospitalGlasgowScotland
  7. 7.Telematics Science LaboratoryKaunas University of TechnologyKaunasLithuania
  8. 8.Department of NeurosurgeryNeurotraumatology Research Unit, Vall d’Hebron University HospitalBarcelonaSpain
  9. 9.Department of NeurosurgeryWestern General HospitalEdinburghScotland