Emergency department ventilation effects outcome in severe traumatic brain injury

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.

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.

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).

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.