Hyperventilation in traumatic brain injury patients: inconsistency between consensus guidelines and clinical practice
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Updated: Oct 2, 2026

Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department
Published on: January 29, 2011
Stephen H Thomas1, Janet Orf, Suzanne K Wedel
1Boston MedFlight Critical Care Transport Service, Boston, Massachusetts, USA. thomas.stephen@mgh.harvard.edu
Background:
This study assessed patients with traumatic brain injury (TBI) to determine whether prehospital and community hospital providers employed hyperventilation therapy inconsistent with consensus recommendation against its routine use.
Methods:
This prospective analysis of 37 intubated TBI patients without herniation, undergoing helicopter transport to an urban Level I center, entailed flight crews' noting of assisted ventilation rate (AVR) and end-tidal carbon dioxide (ETCO2) upon their arrival at trauma scenes or community hospitals. A priori-set levels of AVR and ETCO2 were used to assess frequency of guideline-inconsistent hyperventilation, and Fisher's exact and Kruskal-Wallis tests assessed association between guideline-inconsistent hyperventilation and manual vs. mechanical ventilation mode.
Results:
Inappropriately high AVR and low ETCO2 were seen in 60% and 70% of patients, respectively. Manual ventilation was associated with guideline-inconsistent hyperventilation assessed by AVR (p = 0.038) and ETCO2 (p = 0.022).
Conclusion:
Prehospital and community hospital hyperventilation practices are not consistent with consensus recommendations for limitation of hyperventilation therapy.
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