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Inadequate ventilation of patients with severe brain injury: a possible drawback to prehospital advanced trauma care?

di Bartolomeoa, Stefanoa; Sanson, Gianfrancob; Nardi, Giuseppec; Michelutto, Vannid; Sciane, Franca5

European Journal of Emergency Medicine: December 2003 - Volume 10 - Issue 4 - p 268-271
ORIGINAL ARTICLE
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Objectives: To assess the appropriateness of arterial carbon dioxide tension control in a group of 92 patients with traumatic brain injury who, despite receiving advanced prehospital care, showed no improved outcome in comparison with a group homogeneous but for a lower level of prehospital care.

Methods: A retrospective registration of the early in-hospital arterial carbon dioxide tension of the patients intubated and ventilated on scene. Patients were excluded if the arterial carbon dioxide tension did not reflect prehospital ventilation or its alteration might have been intentional or unavoidable.

Results: Arterial carbon dioxide tension was normal (35–45 mmHg) in only six of the 16 suitable cases (37.5%), was elevated (>45 mmHg) in three cases (18.75%), low (25–35 mmHg) in five cases (31.25%), and extremely low (<25 mmHg) in two cases (12.5%).

Conclusion: Potentially dangerous alterations in capnia occurred in the majority of patients analysed. The possible consequences and causes are discussed. Further studies are needed to assess the consequences of any deviation from ideal standards, and to set realistic standards of arterial carbon dioxide tension control during prehospital ventilation.

aAnaesthesia and Intensive Care, Az. Osp. S.M. Misericordia, 33100 Udine, Italy

bPronto Soccorso, Ospedale di Cattinara, 34100 Trieste, Italy

cShock & Trauma Unit, Ospedale S. Camillo Forlanini, Circonvallazione Giarricolense 87, 00147 Roma, Italy

dAnaesthesia and Intensive Care, Az, Osp. S.M. Misericordia, 33100 Udine, Italy

eServizio di Anestesia, Ospedale SM degli Angeli, 33080 Pordenone, Italy

Correspondence to Dr Stefano Di Bartolomeo, 2nd Service of Anesthesia and Intensive Care, Azienda Ospedaliera S.M.d. Misericordia, Piazza S.M. della Misericordia, 33100 Udine, Italy

Tel: +39 432 552420; fax: +39 432 552421; e-mail: dibartolomeo.stefano@aoud.sanita.fvg.it

A preliminary abstract of this study has been presented as a poster entitled ‘Inadequate ventilation as a possible drawback to advanced prehospital trauma care’ at the Congress Traumacare 2002. Stavanger, Norway, 22–25 May 2002, and has been awarded the third ITAACS prize for the best scientific communication.

© 2003 Lippincott Williams & Wilkins, Inc.