[en] PURPOSE: To describe the management of arterial partial pressure of carbon dioxide (PaCO(2)) in severe traumatic brain-injured (TBI) patients, and the optimal target of PaCO(2) 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 PaCO(2) management during the first week of intensive care unit (ICU) after TBI, focusing on the lowest PaCO(2) values. We also assessed PaCO(2) management in patients with and without ICP monitoring (ICP(m)), and with and without intracranial hypertension. We evaluated the effect of profound hyperventilation (defined as PaCO(2) < 30 mmHg) on long-term outcome. RESULTS: We included 1100 patients, with a total of 11,791 measurements of PaCO(2) (5931 lowest and 5860 highest daily values). The mean (± SD) PaCO(2) was 38.9 (± 5.2) mmHg, and the mean minimum PaCO(2) was 35.2 (± 5.3) mmHg. Mean daily minimum PaCO(2) values were significantly lower in the ICP(m) group (34.5 vs 36.7 mmHg, p < 0.001). Daily PaCO(2) 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. PaCO(2) 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.
Disciplines :
Human health sciences: Multidisciplinary, general & others
Author, co-author :
Citerio, Giuseppe ; School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy. ; Neurointensive Care Unit, Ospedale San Gerardo, Azienda Socio-Sanitaria Territoriale
Robba, Chiara; Anesthesia and Intensive Care, Policlinico San Martino, IRCCS for Oncology and ; Department of Surgical Science and Integrated Diagnostic, University of Genoa,
Rebora, Paola; School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy. ; Bicocca Bioinformatics Biostatistics and Bioimaging Center B4, School of Medicine
Petrosino, Matteo; Bicocca Bioinformatics Biostatistics and Bioimaging Center B4, School of Medicine
Rossi, Eleonora; Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Unit of
Malgeri, Letterio; Anesthesia and Intensive Care, School of Medicine, Messina, Italy.
Stocchetti, Nino; Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy. ; Department of Physiopathology and Transplantation, Milan University, Milan, Italy.
Galimberti, Stefania; School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy. ; Bicocca Bioinformatics Biostatistics and Bioimaging Center B4, School of Medicine
Menon, David K; Neurocritical Care Unit, Addenbrooke's Hospital, Cambridge, UK.
Center-TBI participants and, investigators
Other collaborator :
Åkerlund, Cecilia
Amrein, Krisztina
Andelic, Nada
Andreassen, Lasse
Anke, Audny
Antoni, Anna
Audibert, Gérard
Azouvi, Philippe
Azzolini, Maria Luisa
Bartels, Ronald
Barzó, Pál
Koskinen, Lars-Owe
Kovács, Noémi
Kowark, Ana
Lagares, Alfonso
Lanyon, Linda
LAUREYS, Steven ; Centre Hospitalier Universitaire de Liège - CHU > > Centre du Cerveau²
Lecky, Fiona
LEDOUX, Didier ; Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs
Lefering, Rolf
Legrand, Valerie
Beauvais, Romuald
Lejeune, Aurelie
Levi, Leon
Lightfoot, Roger
Lingsma, Hester
Maas, Andrew I R
Castaño-León, Ana M
Maegele, Marc
Majdan, Marek
Manara, Alex
Manley, Geoffrey
Beer, Ronny
Martino, Costanza
Maréchal, Hugues
Mattern, Julia
McMahon, Catherine
Melegh, Béla
Menon, David
Menovsky, Tomas
Mikolic, Ana
Misset, Benoît ; Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs