Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Aug;36(4):460-465.
doi: 10.1017/S1049023X21000534. Epub 2021 May 31.

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

Mary Beth Howard  1 , Nichole McCollum  1 , Emily C Alberto  2 , Hannah Kotler  3 , Mary E Mottla  4 , Laura Tiusaba  2 , Susan Keller  3 , Ivan Marsic  5 , Aleksandra Sarcevic  6 , Randall S Burd  2 , Karen J O'Connell  1
Affiliations

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

Mary Beth Howard et al. Prehosp Disaster Med. 2021 Aug.

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.

Keywords: resuscitation; traumatic brain injury (TBI); ventilation; wounds and injuries.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
PRISMA Diagram Showing Selection of Articles for Review
See this image and copyright information in PMC

References

    1. Caulfield EV, Dutton RP, Floccare DJ, Stansbury LG, Scalea TM. Prehospital hypocapnia and poor outcome after severe traumatic brain injury. J. Trauma 2009; 66(6):1577–82. - PubMed
    1. Warner KJ, Cuschieri J, Copass MK, Jurkovich GJ, Bulger EM. The impact of prehospital ventilation on outcome after severe traumatic brain injury. J Trauma 2007; 62(6):1330–6. - PubMed
    1. Chestnut RM, Marshall LF, Klauber MR, Blunt BA, Baldin N, Eisenberg HM, et al. The role of secondary brain injury in determining outcome from severe head injury. J Trauma 1993; 34(2):216–222. - PubMed
    1. Raichle ME, Plum F. Hyperventilation and cerebral blood flow. Stroke 1972; 3(5):566–575. - PubMed
    1. Lassen NA. The luxury-perfusion syndrome and its possible relation to acute metabolic acidosis localized within the brain. Lancet 1966; 2(7473):1113–1115. - PubMed

Publication types