Mary Beth Howard1, Nichole McCollum1, Emily C Alberto2, Hannah Kotler3, Mary E Mottla4, Laura Tiusaba2, Susan Keller3, Ivan Marsic5, Aleksandra Sarcevic6, Randall S Burd2, Karen J O'Connell1. 1. Division of Emergency Medicine, Children's National Hospital, Washington, DCUSA. 2. Division of Trauma and Burn Surgery, Children's National Hospital, Washington, DCUSA. 3. Department of Nursing Science, Professional Practice and Quality, Children's National, WashingtonDCUSA. 4. Department of Pediatrics, Children's National Hospital, Washington, DCUSA. 5. Department of Electrical and Computer Engineering, Rutgers University, Piscataway, New JerseyUSA. 6. College of Computing and Informatics, Drexel University, Philadelphia, PennsylvaniaUSA.
Abstract
OBJECTIVES: In the absence of evidence of acute cerebral herniation, normal ventilation is recommended for patients with traumatic brain injury (TBI). Despite this recommendation, ventilation strategies vary during the initial management of patients with TBI and may impact outcome. The goal of this systematic review was to define the best evidence-based practice of ventilation management during the initial resuscitation period. METHODS: A literature search of PubMed, CINAHL, and SCOPUS identified studies from 2009 through 2019 addressing the effects of ventilation during the initial post-trauma resuscitation on patient outcomes. RESULTS: The initial search yielded 899 articles, from which 13 were relevant and selected for full-text review. Six of the 13 articles met the inclusion criteria, all of which reported on patients with TBI. Either end-tidal carbon dioxide (ETCO2) or partial pressure carbon dioxide (PCO2) were the independent variables associated with mortality. Decreased rates of mortality were reported in patients with normal PCO2 or ETCO2. CONCLUSIONS: Normoventilation, as measured by ETCO2 or PCO2, is associated with decreased mortality in patients with TBI. Preventing hyperventilation or hypoventilation in patients with TBI during the early resuscitation phase could improve outcome after TBI.
OBJECTIVES: In the absence of evidence of acute cerebral herniation, normal ventilation is recommended for patients with traumatic brain injury (TBI). Despite this recommendation, ventilation strategies vary during the initial management of patients with TBI and may impact outcome. The goal of this systematic review was to define the best evidence-based practice of ventilation management during the initial resuscitation period. METHODS: A literature search of PubMed, CINAHL, and SCOPUS identified studies from 2009 through 2019 addressing the effects of ventilation during the initial post-trauma resuscitation on patient outcomes. RESULTS: The initial search yielded 899 articles, from which 13 were relevant and selected for full-text review. Six of the 13 articles met the inclusion criteria, all of which reported on patients with TBI. Either end-tidal carbon dioxide (ETCO2) or partial pressure carbon dioxide (PCO2) were the independent variables associated with mortality. Decreased rates of mortality were reported in patients with normal PCO2 or ETCO2. CONCLUSIONS: Normoventilation, as measured by ETCO2 or PCO2, is associated with decreased mortality in patients with TBI. Preventing hyperventilation or hypoventilation in patients with TBI during the early resuscitation phase could improve outcome after TBI.
Entities:
Keywords:
resuscitation; traumatic brain injury (TBI); ventilation; wounds and injuries
Authors: Daniel P Davis; Steve A Aguilar; Kimberly Smith; Ruchika D Husa; Anushirvan Minokadeh; Gary Vilke; Rebecca Sell; Roger Fisher; Criss Brainard; James V Dunford Journal: Prehosp Emerg Care Date: 2014-10-07 Impact factor: 3.077
Authors: Daniel P Davis; James V Dunford; Jennifer C Poste; Mel Ochs; Troy Holbrook; Dale Fortlage; Michael J Size; Frank Kennedy; David B Hoyt Journal: J Trauma Date: 2004-07
Authors: J P Muizelaar; A Marmarou; J D Ward; H A Kontos; S C Choi; D P Becker; H Gruemer; H F Young Journal: J Neurosurg Date: 1991-11 Impact factor: 5.115
Authors: Tom P Aufderheide; Gardar Sigurdsson; Ronald G Pirrallo; Demetris Yannopoulos; Scott McKnite; Chris von Briesen; Christopher W Sparks; Craig J Conrad; Terry A Provo; Keith G Lurie Journal: Circulation Date: 2004-04-05 Impact factor: 29.690
Authors: David Moher; Larissa Shamseer; Mike Clarke; Davina Ghersi; Alessandro Liberati; Mark Petticrew; Paul Shekelle; Lesley A Stewart Journal: Syst Rev Date: 2015-01-01
Authors: Jonathan P Coles; Tim D Fryer; Piotr Smielewski; Doris A Chatfield; Luzius A Steiner; Andrew J Johnston; Stephen P M J Downey; Guy B Williams; Franklin Aigbirhio; Peter J Hutchinson; Kenneth Rice; T Adrian Carpenter; John C Clark; John D Pickard; David K Menon Journal: J Cereb Blood Flow Metab Date: 2004-02 Impact factor: 6.200