Citerio, GRobba, CRebora, PPetrosino, MRossi, EMalgeri, LStocchetti, NGalimberti, SMenon, DKZoerle, TZiverte, AZelinkova, VZeiler, FAYounsi, AYlén, PYang, ZWolf, SWinzeck, SWilson, LWilliams, GWiegers, EKevin, KKWVulekovic, PVoormolen, Dvon Steinbüchel, NVolovici, VVilcinis, RVik, AVespa, PMVerheyden, JVelt, KVega, EVargiolu, Avan Wijk, RPJVyvere, TVvan Veen, EVan Praag, Dvan Heugten, CVan Hecke, Wvan Essen, TAvan Dijck, JTJMNaalt, JVVan der Steen, Gvan der Jagt, MVámos, ZValeinis, EVallance, SVajkoczy, PUnterberg, AMaria Tudora, CTrapani, TTolias, CTimmers, MTibboel, DThomas, MTheadom, ATenovuo, OTe Ao, BTaylor, MSTamosuitis, TTamás, VTakala, RSundström, NSteyerberg, EWStewart, WStevens, RStanworth, SStamatakis, ESorinola, ASmielewski, PSkandsen, TSewalt, CSchwendenwein, ESchou, RFSchoonman, GSchoechl, HSchmidt, SSchäfer, NSandor, JSanchez-Porras, RSakowitz, OSahuquillo, JMartin Rusnák, DRRossi, SRossaint, RRosenthal, GRosenlund, CRosenfeld, JVRosand, JRoise, ORoe, CRocka, SRipatti, SRichter, SRichardson, SRhodes, JHelmrich, IRRambadagalla, MRaj, RRagauskas, A2024-10-292024-10-292021-07-24Intensive Care Medicine, ISSN: 0342-4642 (Print); 1432-1238 (Online), Springer Science and Business Media LLC, 47(9), 961-973. doi: 10.1007/s00134-021-06470-70342-46421432-1238http://hdl.handle.net/10292/18199Purpose: 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.Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.http://creativecommons.org/licenses/by-nc/4.0/Carbon dioxideHyperventilationIntracranial pressureOutcomeTraumatic brain injury32 Biomedical and Clinical Sciences3202 Clinical SciencesBrain DisordersPhysical Injury - Accidents and Adverse EffectsNeurosciencesWomen's HealthTraumatic Brain Injury (TBI)Traumatic Head and Spine Injury1103 Clinical Sciences1117 Public Health and Health ServicesEmergency & Critical Care Medicine3202 Clinical sciencesBrainBrain Injuries, TraumaticCarbon DioxideCohort StudiesHumansIntracranial PressurePartial PressureProspective StudiesBrainBrain Injuries, TraumaticCarbon DioxideCohort StudiesHumansIntracranial PressurePartial PressureProspective StudiesJournal ArticleOpenAccess10.1007/s00134-021-06470-7