Management of arterial partial pressure of carbon dioxide in the first week after traumatic brain injury: results from the CENTER-TBI study

• Published in: Intensive care medicine Vol. 47; no. 9; pp. 961 - 973
• Main Authors: Citerio, Giuseppe, Robba, Chiara, Rebora, Paola, Petrosino, Matteo, Rossi, Eleonora, Malgeri, Letterio, Stocchetti, Nino, Galimberti, Stefania, Menon, David K.
• Format: Journal Article Web Resource
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2021; Springer; Springer Nature B.V
• Subjects: 142M471B3J (Carbon Dioxide); Analysis; Anesthesiology; Blood pressure; Brain; Brain Injuries, Traumatic - complications; Brain Injuries, Traumatic - therapy; Brain Injuries, Traumatic/complications/therapy; Carbon Dioxide; Cohort Studies; Critical Care Medicine; Emergency Medicine; Head injuries; Heterogeneity; Human health sciences; Humans; Hypertension; Hyperventilation; Intensive; Intensive care; Intracranial Pressure; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Monitoring; Original; Outcome; Pain Medicine; Partial Pressure; Pediatrics; Pneumology/Respiratory System; Prospective Studies; Sciences de la santé humaine; Secondary analysis; Traumatic brain injury; Hungary; United Kingdom; Spain; Austria; Netherlands; Sweden; Belgium; Norway; Finland; Denmark; France; Australia; Germany; Traumatic brain injury; Intracranial pressure; Hyperventilation; Outcome; Carbon dioxide
• ISSN: 0342-4642; 1432-1238; 1432-1238
• DOI: 10.1007/s00134-021-06470-7

Purpose To describe the management of arterial partial pressure of carbon dioxide (PaCO 2 ) in severe traumatic brain-injured (TBI) patients, and the optimal target of PaCO 2 in patients with high intracranial pressure (ICP). Methods Secondary analysis of CENTER-TBI, a multicentre, prospective, observational, cohort study. The primary aim was to describe current practice in PaCO 2 management during the first week of intensive care unit (ICU) after TBI, focusing on the lowest PaCO 2 values. We also assessed PaCO 2 management in patients with and without ICP monitoring (ICP m ), and with and without intracranial hypertension. We evaluated the effect of profound hyperventilation (defined as PaCO 2  < 30 mmHg) on long-term outcome. Results We included 1100 patients, with a total of 11,791 measurements of PaCO 2 (5931 lowest and 5860 highest daily values). The mean (± SD) PaCO 2 was 38.9 (± 5.2) mmHg, and the mean minimum PaCO 2 was 35.2 (± 5.3) mmHg. Mean daily minimum PaCO 2 values were significantly lower in the ICP m group (34.5 vs 36.7 mmHg, p  < 0.001). Daily PaCO 2 nadir was lower in patients with intracranial hypertension (33.8 vs 35.7 mmHg, p  < 0.001). Considerable heterogeneity was observed between centers. Management in a centre using profound hyperventilation (HV) more frequently was not associated with increased 6 months mortality (OR = 1.06, 95% CI = 0.77–1.45, p value = 0.7166), or unfavourable neurological outcome (OR 1.12, 95% CI = 0.90–1.38, p value = 0.3138). Conclusions Ventilation is manipulated differently among centers and in response to intracranial dynamics. PaCO 2 tends to be lower in patients with ICP monitoring, especially if ICP is increased. Being in a centre which more frequently uses profound hyperventilation does not affect patient outcomes.