Head Injury and Hyperventilation - page 2

by NO50FRANNY 11,497 Views | 14 Comments

Hi all, Just wanted to see if this is a common theme across facilities. I have noticed there is a tendency both pre-hospital and in Emergency to hyperventilate / hyperoxygenate patients with traumatic brain injuries. I... Read More


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    I was reading about this the other day cause it seems to be a hot topic in current treatment of TBI's. The Guidelines for Management of Severe Traumatic Brain Injury do not recommend prophylactic hyperventilation (PaCO2 less than 25 mm Hg). Keep the PaCO2 between 30 and 35 mm Hg for the first 24 hours. If hyperventilation is being used, recommendations suggest measuring cerebral oxygenation (SjO2, PbrO2...). A quick simple way to measure effectiveness of ventilations without an ABG is ETCO2 monitoring. Current therapy recommends keeping ETCO2 35-40 mm Hg. Levels below 35 should be avoided; however, in some instances (evidence of herniation or acute neuro deterioration) it is fine to hyperventilate with a goal of maintaining an ETCO2 30-35 mm Hg and discontinue when signs of herniation are alleviated.

    Hope this helps a little.
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    [quote]
    anectodally, women tend to be on the receiving end of "over" ventilating for obvious reasons.
    /quote]

    i am not sure what the obvious reasons are? what am i missing? otherwise very helpful information.
  3. 0
    Quote from TRUtraumaRN
    Keep the PaCO2 between 30 and 35 mm Hg for the first 24 hours..... it is fine to hyperventilate with a goal of maintaining an ETCO2 30-35 mm Hg and discontinue when signs of herniation are alleviated.
    I am having trouble finding reference to these exact numbers in the guidelines you mentioned. It would help me tremendously if you could direct me to something that references 30-35 specifically. Thanks!!
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  5. 0
    [quote=sarah22p;6696147]
    anectodally, women tend to be on the receiving end of "over" ventilating for obvious reasons.
    /quote]

    i am not sure what the obvious reasons are? what am i missing? otherwise very helpful information.
    just generally smaller lungs


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