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Association of Ventilation during Initial Trauma Resuscitation for Traumatic Brain Injury and Post-Traumatic Outcomes: A Systematic Review

Published online by Cambridge University Press:  31 May 2021

Mary Beth Howard
Affiliation:
Division of Emergency Medicine, Children’s National Hospital, Washington, DCUSA
Nichole McCollum
Affiliation:
Division of Emergency Medicine, Children’s National Hospital, Washington, DCUSA
Emily C. Alberto
Affiliation:
Division of Trauma and Burn Surgery, Children’s National Hospital, Washington, DCUSA
Hannah Kotler
Affiliation:
Department of Nursing Science, Professional Practice and Quality, Children’s National, WashingtonDCUSA
Mary E. Mottla
Affiliation:
Department of Pediatrics, Children’s National Hospital, Washington, DCUSA
Laura Tiusaba
Affiliation:
Division of Trauma and Burn Surgery, Children’s National Hospital, Washington, DCUSA
Susan Keller
Affiliation:
Department of Nursing Science, Professional Practice and Quality, Children’s National, WashingtonDCUSA
Ivan Marsic
Affiliation:
Department of Electrical and Computer Engineering, Rutgers University, Piscataway, New JerseyUSA
Aleksandra Sarcevic
Affiliation:
College of Computing and Informatics, Drexel University, Philadelphia, PennsylvaniaUSA
Randall S. Burd
Affiliation:
Division of Trauma and Burn Surgery, Children’s National Hospital, Washington, DCUSA
Karen J. O’Connell*
Affiliation:
Division of Emergency Medicine, Children’s National Hospital, Washington, DCUSA
*
Correspondence: Karen J. O’Connell, MD, Med Division of Emergency Medicine Children’s National Hospital 111 Michigan Ave NW, WashingtonDC20010USA E-mail: koconnel@childrensnational.org

Abstract

Objectives:

In the absence of evidence of acute cerebral herniation, normal ventilation is recommended for patients with traumatic brain injury (TBI). Despite this recommendation, ventilation strategies vary during the initial management of patients with TBI and may impact outcome. The goal of this systematic review was to define the best evidence-based practice of ventilation management during the initial resuscitation period.

Methods:

A literature search of PubMed, CINAHL, and SCOPUS identified studies from 2009 through 2019 addressing the effects of ventilation during the initial post-trauma resuscitation on patient outcomes.

Results:

The initial search yielded 899 articles, from which 13 were relevant and selected for full-text review. Six of the 13 articles met the inclusion criteria, all of which reported on patients with TBI. Either end-tidal carbon dioxide (ETCO2) or partial pressure carbon dioxide (PCO2) were the independent variables associated with mortality. Decreased rates of mortality were reported in patients with normal PCO2 or ETCO2.

Conclusions:

Normoventilation, as measured by ETCO2 or PCO2, is associated with decreased mortality in patients with TBI. Preventing hyperventilation or hypoventilation in patients with TBI during the early resuscitation phase could improve outcome after TBI.

Type
Systematic Review
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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Footnotes

Note: Drs. Howard and McCollum have shared co-authorship.

References

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