Neurocritical Care

, Volume 30, Issue 2, pp 405–413 | Cite as

Spontaneous Hyperventilation in Severe Traumatic Brain Injury: Incidence and Association with Poor Neurological Outcome

  • Pierre EsnaultEmail author
  • Johanna Roubin
  • Mickael Cardinale
  • Erwan D’Aranda
  • Ambroise Montcriol
  • Pierre-Julien Cungi
  • Philippe Goutorbe
  • Christophe Joubert
  • Arnaud Dagain
  • Eric Meaudre
Original Article



Hypocapnia induces cerebral vasoconstriction leading to a decrease in cerebral blood flow, which might precipitate cerebral ischemia. Hypocapnia can be intentional to treat intracranial hypertension or unintentional due to a spontaneous hyperventilation (SHV). SHV is frequent after subarachnoid hemorrhage. However, it is understudied in patients with severe traumatic brain injury (TBI). The objective of this study was to describe the incidence and consequences on outcome of SHV after severe TBI.


We conducted a retrospective, observational study including all intubated TBI patients admitted in the trauma center and still comatose 24 h after the withdrawal of sedation. SHV was defined by the presence of at least one arterial blood gas (ABG) with both PaCO2 < 35 mmHg and pH > 7.45. Patient characteristics and outcome were extracted from a prospective registry of all intubated TBI admitted in the intensive care unit. ABG results were retrieved from patient files. A multivariable logistic regression model was developed to determine factors independently associated with unfavorable outcome (defined as a Glasgow Outcome Scale between 1 and 3) at 6-month follow-up.


During 7 years, 110 patients fully respecting inclusion criteria were included. The overall incidence of SHV was 69.1% (95% CI [59.9–77]). Patients with SHV were more severely injured (median head AIS score (5 [4–5] vs. 4 [4–5]; p = 0.016)) and exhibited an elevated morbidity during their stay. The proportion of patients with an unfavorable functional neurologic outcome was significantly higher in patients with SHV: 40 (52.6%) versus 6 (17.6%), p = 0.0006. After adjusting for confounders, SHV remains an independent factor associated with unfavorable outcome at the 6-month follow-up (OR 4.1; 95% CI [1.2–14.4]).


SHV is common in patients with a persistent coma after a severe TBI (overall rate: 69%) and was independently associated with unfavorable outcome at 6-month follow-up.


Severe traumatic brain injury Spontaneous hyperventilation Hypocapnia Respiratory alkalosis Glasgow Outcome Scale 



Traumatic brain injury


Glasgow Coma Scale


Cerebral perfusion pressure


Brain tissue oxygen tension


Intensive care unit


Intracranial pressure


Oxygen inspired fraction


Glasgow Outcome Scale


Receiver operating characteristic

95% CI

95% confidence intervals


Authors’ contributions

PE, JR, and CJ contributed to the study concept and design. PE, JR, MC, ED, AM, PJC, and AS contributed to the acquisition of data. PE, PG, AD, and BP contributed to the analysis and interpretation of data. PE, PG, JB, and EM contributed to the drafting of manuscript and critical revision of the manuscript for important intellectual content. All authors read and approved the final manuscript.

Source of support


Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest to report.

Ethical Approval and Consent to Participate

Institutional Review Board of the Sainte Anne Military Hospital, Toulon (France), approved the study and waived the requirement for informed consent from the patients or patient’s kin given the observational nature of the study.

Supplementary material

12028_2018_639_MOESM1_ESM.docx (13 kb)
Additional Table. Comparison between Arterial Blood Gas with Spontaneous Hyperventilation criteria and those without. (DOCX 12 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2018

Authors and Affiliations

  • Pierre Esnault
    • 1
    Email author
  • Johanna Roubin
    • 1
  • Mickael Cardinale
    • 1
  • Erwan D’Aranda
    • 1
  • Ambroise Montcriol
    • 1
  • Pierre-Julien Cungi
    • 1
  • Philippe Goutorbe
    • 1
  • Christophe Joubert
    • 2
  • Arnaud Dagain
    • 2
    • 3
  • Eric Meaudre
    • 1
    • 3
  1. 1.Intensive Care UnitSainte Anne Military HospitalToulonFrance
  2. 2.Department of NeurosurgerySainte Anne Military HospitalToulonFrance
  3. 3.French Military Health Service Academy UnitParisFrance

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