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58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

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Current status on hyperventilation therapy after traumatic brain injury in Europe - Results from the Brain-IT initiative

Klinische Anwendung der Hyperventilation nach Schädel-Hirn-Trauma in Europa - Ergebnisse der Brain-IT-Initiative

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  • corresponding author J.-O. Neumann - Neurochirurgische Klinik, Universitätsklinikum Heidelberg
  • K. L. Kiening - Neurochirurgische Klinik, Universitätsklinikum Heidelberg
  • Brain-IT Study Group - Neurochirurgische Klinik, Universitätsklinikum Heidelberg

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocFR.06.01

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2007/07dgnc096.shtml

Published: April 11, 2007

© 2007 Neumann et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Use of hyperventilation has been restricted by the Brain Trauma Foundation-Guidelines (BTF-G) because of its negative impact on cerebral blood flow/oxygenation and clinical outcome. This retrospective analysis presents HV data on 200 consecutive patients with severe traumatic brain injury (TBI) from 30 European centers, enrolled into a common database, developed by the Brain-IT initiative (http://www.brainit.org).

Methods: 7,703 blood-gas analyses (BGA) from 162 patients, representing 2,269 episodes of ventilation – defined as consecutive BGAs within a specific paCO2 class – were included in the analysis. Related minute-by-minute ICP data were taken from a 30-minute time window around BGA collection. Subsequently, episodes were divided into two groups (<24 hrs and ≥24 hours post trauma) and analyzed. Data are given as mean ± standard deviation.

Results: (1) Patients without raised ICP (<20 mmHg) revealed a significantly higher paCO2 (36±5.7 mmHg) in comparison to patients with a raised ICP (≥20 mmHg, paCO2: 34±5.4 mmHg, p<0.001). (2) Intensified forced HV (paCO2 ≤25 mmHg) in the absence of raised ICP was found in only 2% of the time (49 episodes). (3) Early after TBI (<24 hours), paCO2 was 36±5.6 mmHg and stayed at the same level (36±6.3 mmHg) in the subsequent time interval (≥24 hours). (4) However, in contrast to BTF-G, early prophylactic HV (<24 hours after TBI, paCO2≤35 mmHg, ICP<20 mmHg) was used in 57% of all corresponding episodes. (5) During forced HV (paCO2≤30 mmHg), simultaneous monitoring of brain tissue pO2 or jugular vein oxygen saturation was used in only 29 out of 331 episodes.

Conclusions: HV is used extensively in the treatment of severe TBI in Europe. While overall adherence to current BTF-G is acceptable, the recommendations on early prophylactic HV (≤35 mmHg) as well as the use of additional cerebral oxygenation monitoring during forced HV are not followed in the majority of European TBI centers. Thus, patients with severe TBI are at risk for additional cerebral ischemic insults.