Original ArticlesEmergency Department Ventilation Effects Outcome in Severe Traumatic Brain InjuryWarner, Keir J. BS; Cuschieri, Joseph MD; Copass, Michael K. MD; Jurkovich, Gregory J. MD; Bulger, Eileen M. MDAuthor Information From the Department of Surgery (K.J.W., J.C., G.J.J., E.M.B.) and Emergency Services (M.K.C.), University of Washington, Harborview Medical Center, Seattle, Washington. Submitted for publication March 3, 2007. Accepted for publication November 1, 2007. Supported by a grant from the Brain Trauma Foundation. Presented at the 37th Annual Meeting of the Western Trauma Association, February 25–March 2, 2007, Steamboat Springs, Colorado. Address for reprints: Keir J. Warner, BS, Box 359796, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104; email: [email protected]. The Journal of Trauma: Injury, Infection, and Critical Care: February 2008 - Volume 64 - Issue 2 - p 341-347 doi: 10.1097/TA.0b013e318160dfb3 Buy Metrics Abstract Background: Recently, we have demonstrated that patients with traumatic brain injury (TBI) with an arrival PaCo2 30 to 35 mm Hg have improved outcome compared with those outside this target range. We sought to determine whether achieving ventilation into a target range would translate into better outcomes in patients with TBI. Methods: Data were retrospectively reviewed for all trauma prehospital intubations during a period of 24 months (n = 851). Targeted ventilation was defined as a PaCo2 between 30 and 39 mm Hg. Arterial blood gases collected within 15 minutes of patient arrival were assessed and compared with subsequent arterial blood gases to determine patient's ventilation status over time. Results: There was no difference in patient demographics between various ventilation groups. Patients with TBI who achieved the target range had a mortality of 21.2% compared with 33.7% for those who persistently remained outside this range (p = 0.03). Logistic regression demonstrated a trend toward lower mortality for those TBI patients who achieved the target range while in the emergency department (odds ratio 0.33, 95% confidence interval 0.15–0.75). Conclusion: Optimal outcome is achieved when the patient is in the target ventilation range on arrival and remains within it. Ventilation status in trauma patients should be closely monitored after intubation to develop an optimal ventilation strategy for patients with severe TBI. © 2008 Lippincott Williams & Wilkins, Inc.