The use of hyperventilation therapy after traumatic brain injury in Europe: an analysis of the BrainIT database

Objective: To assess the use of hyperventilation and the adherence to Brain Trauma Foundation-Guidelines (BTF-G) after traumatic brain injury (TBI). Setting: Twenty-two European centers are participating in the BrainIT initiative. Design: Retrospective analysis of monitoring data. Patients and participants: One hundred and fifty-one patients with a known time of trauma and at least one recorded arterial blood-gas (ABG) analysis. Measurements and results: A total number of 7,703 ABGs, representing 2,269 ventilation episodes (VE) were included in the analysis. Related minute-by-minute ICP data were taken from a 30 min time window around each ABG collection. Data are given as mean with standard deviation. (1) Patients without elevated intracranial pressure (ICP) (< 20 mmHg) manifested a statistically significant higher PaCO2 (36 +/- 5.7 mmHg) in comparison to patients with elevated ICP (< 20 mmHg; PaCO2: 34 +/- 5.4 mmHg, P < 0.001). (2) Intensified forced hyperventilation (PaCO2 <= 25 mmHg) in the absence of elevated ICP was found in only 49 VE (2%). (3) Early prophylactic hyperventilation (< 24 h after TBI; PaCO2 <= 35 mmHg, ICP < 20 mmHg) was used in 1,224 VE (54%). (4) During forced hyperventilation (PaCO2 <= 30 mmHg), simultaneous monitoring of brain tissue pO(2) or SjvO2 was used in only 204 VE (9%). Conclusion: While overall adherence to current BTF-G seems to be the rule, its recommendations on early prophylactic hyperventilation as well as the use of additional cerebral oxygenation monitoring during forced hyperventilation are not followed in this sample of European TBI centers. Descriptor: Neurotrauma.