Management of Arterial Partial Pressure of Carbon Dioxide in the First Week After Traumatic Brain Injury: Results From the CENTER-TBI Study

Date
2021-07-24
Authors
Citerio, G
Robba, C
Rebora, P
Petrosino, M
Rossi, E
Malgeri, L
Stocchetti, N
Galimberti, S
Menon, DK
Zoerle, T
Supervisor
Item type
Journal Article
Degree name
Journal Title
Journal ISSN
Volume Title
Publisher
Springer Science and Business Media LLC
Abstract

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.

Description
Keywords
Carbon dioxide , Hyperventilation , Intracranial pressure , Outcome , Traumatic brain injury , 32 Biomedical and Clinical Sciences , 3202 Clinical Sciences , Brain Disorders , Physical Injury - Accidents and Adverse Effects , Neurosciences , Women's Health , Traumatic Brain Injury (TBI) , Traumatic Head and Spine Injury , 1103 Clinical Sciences , 1117 Public Health and Health Services , Emergency & Critical Care Medicine , 3202 Clinical sciences
Source
Intensive Care Medicine, ISSN: 0342-4642 (Print); 1432-1238 (Online), Springer Science and Business Media LLC, 47(9), 961-973. doi: 10.1007/s00134-021-06470-7
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