TY - JOUR
T1 - Management of arterial partial pressure of carbon dioxide in the first week after traumatic brain injury
T2 - results from the CENTER-TBI study
AU - Citerio, Giuseppe
AU - Robba, Chiara
AU - Rebora, Paola
AU - Petrosino, Matteo
AU - Rossi, Eleonora
AU - Malgeri, Letterio
AU - Stocchetti, Nino
AU - Galimberti, Stefania
AU - Menon, David K.
AU - van Heugten, Caroline M.
AU - CENTER-TBI Participants and Investigators
N1 - Publisher Copyright:
© 2021. The Author(s).
PY - 2021/9
Y1 - 2021/9
N2 - Purpose To describe the management of arterial partial pressure of carbon dioxide (PaCO2) in severe traumatic brain-injured (TBI) patients, and the optimal target of PaCO2 in patients with high intracranial pressure (ICP). Methods Secondary analysis of CENTER-TBI, a multicentre, prospective, observational, cohort study. The primary aim was to describe current practice in PaCO2 management during the first week of intensive care unit (ICU) after TBI, focusing on the lowest PaCO2 values. We also assessed PaCO2 management in patients with and without ICP monitoring (ICPm), and with and without intracranial hypertension. We evaluated the effect of profound hyperventilation (defined as PaCO2 < 30 mmHg) on long-term outcome. Results We included 1100 patients, with a total of 11,791 measurements of PaCO2 (5931 lowest and 5860 highest daily values). The mean (+/- SD) PaCO2 was 38.9 (+/- 5.2) mmHg, and the mean minimum PaCO2 was 35.2 (+/- 5.3) mmHg. Mean daily minimum PaCO2 values were significantly lower in the ICPm group (34.5 vs 36.7 mmHg, p < 0.001). Daily PaCO2 nadir was lower in patients with intracranial hypertension (33.8 vs 35.7 mmHg, p < 0.001). Considerable heterogeneity was observed between centers. Management in a centre using profound hyperventilation (HV) more frequently was not associated with increased 6 months mortality (OR = 1.06, 95% CI = 0.77-1.45, p value = 0.7166), or unfavourable neurological outcome (OR 1.12, 95% CI = 0.90-1.38, p value = 0.3138). Conclusions Ventilation is manipulated differently among centers and in response to intracranial dynamics. PaCO2 tends to be lower in patients with ICP monitoring, especially if ICP is increased. Being in a centre which more frequently uses profound hyperventilation does not affect patient outcomes.
AB - Purpose To describe the management of arterial partial pressure of carbon dioxide (PaCO2) in severe traumatic brain-injured (TBI) patients, and the optimal target of PaCO2 in patients with high intracranial pressure (ICP). Methods Secondary analysis of CENTER-TBI, a multicentre, prospective, observational, cohort study. The primary aim was to describe current practice in PaCO2 management during the first week of intensive care unit (ICU) after TBI, focusing on the lowest PaCO2 values. We also assessed PaCO2 management in patients with and without ICP monitoring (ICPm), and with and without intracranial hypertension. We evaluated the effect of profound hyperventilation (defined as PaCO2 < 30 mmHg) on long-term outcome. Results We included 1100 patients, with a total of 11,791 measurements of PaCO2 (5931 lowest and 5860 highest daily values). The mean (+/- SD) PaCO2 was 38.9 (+/- 5.2) mmHg, and the mean minimum PaCO2 was 35.2 (+/- 5.3) mmHg. Mean daily minimum PaCO2 values were significantly lower in the ICPm group (34.5 vs 36.7 mmHg, p < 0.001). Daily PaCO2 nadir was lower in patients with intracranial hypertension (33.8 vs 35.7 mmHg, p < 0.001). Considerable heterogeneity was observed between centers. Management in a centre using profound hyperventilation (HV) more frequently was not associated with increased 6 months mortality (OR = 1.06, 95% CI = 0.77-1.45, p value = 0.7166), or unfavourable neurological outcome (OR 1.12, 95% CI = 0.90-1.38, p value = 0.3138). Conclusions Ventilation is manipulated differently among centers and in response to intracranial dynamics. PaCO2 tends to be lower in patients with ICP monitoring, especially if ICP is increased. Being in a centre which more frequently uses profound hyperventilation does not affect patient outcomes.
KW - Carbon dioxide
KW - Hyperventilation
KW - Traumatic brain injury
KW - Intracranial pressure
KW - Outcome
KW - HEAD-INJURY
KW - HYPERVENTILATION
KW - GUIDELINES
U2 - 10.1007/s00134-021-06470-7
DO - 10.1007/s00134-021-06470-7
M3 - Article
C2 - 34302517
SN - 0342-4642
VL - 47
SP - 961
EP - 973
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 9
ER -