Brian W Roberts1, Paul Karagiannis2, Michael Coletta3, J Hope Kilgannon4, Michael E Chansky5, Stephen Trzeciak6. 1. Department of Emergency Medicine, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA. Electronic address: roberts-brian-w@cooperhealth.edu. 2. Department of Emergency Medicine, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA. Electronic address: Karagiannis-Paul@cooperhealth.edu. 3. Department of Emergency Medicine, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA. Electronic address: colett58@rowan.edu. 4. Department of Emergency Medicine, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA. Electronic address: Kilgannon-Hope@cooperhealth.edu. 5. Department of Emergency Medicine, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA. Electronic address: Chansky-Michael@cooperhealth.edu. 6. Department of Emergency Medicine, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA; Department of Medicine, Division of Critical Care Medicine (ST), Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA. Electronic address: Trzeciak-Stephen@cooperhealth.edu.
Abstract
OBJECTIVE: Partial pressure of arterial carbon dioxide (PaCO2) is a major regulator of cerebral blood flow (CBF). Derangements in PaCO2 have been thought to worsen clinical outcomes after many forms of cerebral injury by altering CBF. Our aim was to systematically analyze the biomedical literature to determine the effects of PaCO2 derangements on clinical outcomes after cerebral injury. METHODS: We performed a search of Cochrane Library, PUBMED, CINHAL, conference proceedings, and other sources using a comprehensive strategy. Study inclusion criteria were (1) human subjects; (2) cerebral injury; (3) mechanical ventilation post-injury; (4) measurement of PaCO2; and (5) comparison of a clinical outcome measure (e.g. mortality) between different PaCO2 exposures. We performed a qualitative analysis to collate and summarize effects of PaCO2 derangements according to the recommended methodology from the Cochrane Handbook. RESULTS: Seventeen studies involving different etiologies of cerebral injury (six traumatic brain injury, six post-cardiac arrest syndrome, two cerebral vascular accident, three neonatal ischemic encephalopathy) met all inclusion and no exclusion criteria. Three randomized control trials were identified and only one was considered a high quality study as per the Cochrane criteria for assessing risk of bias. In 13/17 (76%) studies examining hypocapnia, and 7/10 (70%) studies examining hypercapnia, the exposed group (hypercapnia or hypocapnia) was associated with poor clinical outcome. CONCLUSION: The majority of studies in this report found exposure to hypocapnia and hypercapnia after cerebral injury to be associated with poor clinical outcome. However, the optimal PaCO2 range associated with good clinical outcome remains unclear.
OBJECTIVE: Partial pressure of arterial carbon dioxide (PaCO2) is a major regulator of cerebral blood flow (CBF). Derangements in PaCO2 have been thought to worsen clinical outcomes after many forms of cerebral injury by altering CBF. Our aim was to systematically analyze the biomedical literature to determine the effects of PaCO2 derangements on clinical outcomes after cerebral injury. METHODS: We performed a search of Cochrane Library, PUBMED, CINHAL, conference proceedings, and other sources using a comprehensive strategy. Study inclusion criteria were (1) human subjects; (2) cerebral injury; (3) mechanical ventilation post-injury; (4) measurement of PaCO2; and (5) comparison of a clinical outcome measure (e.g. mortality) between different PaCO2 exposures. We performed a qualitative analysis to collate and summarize effects of PaCO2 derangements according to the recommended methodology from the Cochrane Handbook. RESULTS: Seventeen studies involving different etiologies of cerebral injury (six traumatic brain injury, six post-cardiac arrest syndrome, two cerebral vascular accident, three neonatal ischemicencephalopathy) met all inclusion and no exclusion criteria. Three randomized control trials were identified and only one was considered a high quality study as per the Cochrane criteria for assessing risk of bias. In 13/17 (76%) studies examining hypocapnia, and 7/10 (70%) studies examining hypercapnia, the exposed group (hypercapnia or hypocapnia) was associated with poor clinical outcome. CONCLUSION: The majority of studies in this report found exposure to hypocapnia and hypercapnia after cerebral injury to be associated with poor clinical outcome. However, the optimal PaCO2 range associated with good clinical outcome remains unclear.
Authors: Ciara E Keogh; Carsten C Scholz; Javier Rodriguez; Andrew C Selfridge; Alexander von Kriegsheim; Eoin P Cummins Journal: J Biol Chem Date: 2017-05-15 Impact factor: 5.157
Authors: Brian M Fuller; Nicholas M Mohr; Anne M Drewry; Ian T Ferguson; Stephen Trzeciak; Marin H Kollef; Brian W Roberts Journal: J Crit Care Date: 2017-04-26 Impact factor: 3.425
Authors: Arne Diehl; Aidan J C Burrell; Andrew A Udy; Peta M A Alexander; Peter T Rycus; Ryan P Barbaro; Vincent A Pellegrino; David V Pilcher Journal: Crit Care Med Date: 2020-07 Impact factor: 7.598
Authors: J Hope Kilgannon; Benton R Hunter; Michael A Puskarich; Lisa Shea; Brian M Fuller; Christopher Jones; Michael Donnino; Jeffrey A Kline; Alan E Jones; Nathan I Shapiro; Benjamin S Abella; Stephen Trzeciak; Brian W Roberts Journal: Resuscitation Date: 2018-11-16 Impact factor: 5.262
Authors: Katherine Cashen; Ron Reeder; Heidi J Dalton; Robert A Berg; Thomas P Shanley; Christopher J L Newth; Murray M Pollack; David Wessel; Joseph Carcillo; Rick Harrison; J Michael Dean; Robert Tamburro; Kathleen L Meert Journal: Pediatr Crit Care Med Date: 2018-03 Impact factor: 3.624
Authors: Nicolas Deye; François Vincent; Philippe Michel; Stephan Ehrmann; Daniel da Silva; Michael Piagnerelli; Antoine Kimmoun; Olfa Hamzaoui; Jean-Claude Lacherade; Bernard de Jonghe; Florence Brouard; Corinne Audoin; Xavier Monnet; Pierre-François Laterre Journal: Ann Intensive Care Date: 2016-01-12 Impact factor: 6.925