Early ventilation and outcome in patients with moderate to severe traumatic brain injury*

Davis, Daniel P.; Idris, Ahamed H.; Sise, Michael J.; Kennedy, Frank; Eastman, A. Brent; Velky, Thomas; Vilke, Gary M.; Hoyt, David B.

doi:10.1097/01.ccm.0000208359.74623.1c

Cited by 159 publications

(128 citation statements)

References 79 publications

Supporting

Mentioning

121

Contrasting

Unclassified

Order By: Relevance

“…Nonneurological organ dysfunction is an important predictor 66 Early physiological derangements are known to be associated with worse outcomes, and their timely correction could influence recovery. [67][68][69] Consistent with this notion, one randomized controlled trial demonstrated that pre-hospital rapid sequence intubation (RSI) by paramedics increased the proportion of TBI patients with a favourable neurological recovery. 14 Pre-hospital RSI was routine practice in Southern Alberta even before the time period assessed in this study.…”

Section: Discussionmentioning

confidence: 93%

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

Kramer

Zygun

2013

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 93%

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

Kramer

Zygun

2013

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

“…35,36 Patients who are hyperventilated are more likely to be in a persistent vegetative state or require permanent assistance with activities of daily living if they survive their hospitalization. In contrast, investigators have shown that normocapnia in TBI is associated with less neurologic impairment and better functional independence.…”

Section: Hypocapnia In Tbimentioning

confidence: 99%

Carbon Dioxide in the Critically Ill: Too Much or Too Little of a Good Thing?

Marhong

Fan

2014

Respir Care

View full text Add to dashboard Cite

Hypercapnia and hypocapnia commonly complicate conditions that are present in critically ill patients. Both conditions have important physiologic effects that may impact the clinical management of these patients. For instance, hypercapnia results in bronchodilation and enhanced hypoxic vasoconstriction, leading to improved ventilation/perfusion matching. Hypocapnia reduces cerebral blood volume through arterial vasoconstriction. These effects have also been exploited for therapeutic aims. In patients with traumatic brain injury (TBI), hypocapnia is often utilized to control intracranial pressure. However, this effect is not sustained, and prolonged hypocapnia increases the risk of mortality and severe disability in patients with TBI. Hypercapnia and hypercapnic acidosis are common consequences of lung-protective ventilation in ARDS. Hypercapnic acidosis reduces ischemic lung injury and preserves lung compliance, but concern has arisen over hypercapniainduced immunosuppression and the potential for bacterial proliferation in sepsis. Experimental studies suggest that buffering hypercapnic acidosis attenuates these effects, whereas hypocapnia appears to potentiate lung injury through increased capillary permeability and decreased lung compliance. Several areas of uncertainty surround the role of hypercapnia/hypocapnia in treating TBI and ARDS. Current data support recommendations to avoid hypocapnia in treating TBI, with the exception of emergent treatment of elevated intracranial pressure, while awaiting definitive management. Permissive hypercapnia is commonly accepted as a consequence of lung-protective ventilation in ARDS, but there is insufficient evidence to support the induction of hypercapnic acidosis in clinical practice. Buffering hypercapnic acidosis should be considered only for a specific clinical indication (eg, hemodynamic instability). For clinicians choosing to buffer hypercapnic acidosis, tris-hydroxymethyl aminomethane is recommended over sodium bicarbonate, as it is more effective in correcting pH and is not associated with increased carbon dioxide production. Future studies should aim to address these areas of uncertainty to help guide clinicians in the therapeutic use and management of hypercapnia/hypocapnia in critically ill patients.

show abstract

“…The possible detrimental impact of prehospital intubation is associated with the risk of hyperventilation and positive pressure ventilation. Hyperventilation (9) and hypoventilation (28,29) in intubated patients with TBI increase the mortality rate. Only targeted prehospital ventilation is associated with lower mortality rate.…”

Section: Discussionmentioning

confidence: 99%

“…Positive pressure ventilation increases intrathoracic pressure, which reduces the venous return and decreases blood pressure and cardiac output. (10,22,28) Increased intrathoracic pressure can be retrogradely transmitted through the jugular venous system raising intracranial pressure as a result. (31) However, hyperventilation reduces ICP through vasoconstriction (17) and is recommended as a treatment in patients with acute brainstem herniation.…”

Section: Discussionmentioning

confidence: 99%

Impact of pre-hospital oxygenation and ventilation status on outcome in patients with isolated severe traumatic brain injury

Strnad

Popovic

Lesjak

et al. 2014

View full text Add to dashboard Cite

Introduction. Hypoxia is one of the secondary insults and it worsens the outcome in patients with severe traumatic brain injury (TBI). (CPC), and GCS score at discharge) when all six groups were compared together. We were unable to prove a deleterious effect of hypoxia or hyperoxia compared to normoxia on rate of survival to hospital discharge (STHD) (0.38 (0.52) vs 0.50 (0.51) vs 0.65 (0.49), f = 1.246, p = 0.298

show abstract

Early ventilation and outcome in patients with moderate to severe traumatic brain injury*

Abstract: Arrival hypercapnia and hypocapnia are common and associated with worse outcomes in intubated but not spontaneously breathing patients with traumatic brain injury.

Cited by 159 publications

References 79 publications

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

Carbon Dioxide in the Critically Ill: Too Much or Too Little of a Good Thing?

Impact of pre-hospital oxygenation and ventilation status on outcome in patients with isolated severe traumatic brain injury

Contact Info

Product

Resources

About