학술논문
Association between prehospital end-tidal carbon dioxide levels and mortality in patients with suspected severe traumatic brain injury.
Document Type
Academic Journal
Author
Bossers SM; Department of Anesthesiology, Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. s.bossers@amsterdamumc.nl.; Mansvelder F; Department of Anesthesiology, Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.; Loer SA; Department of Anesthesiology, Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.; Boer C; Department of Anesthesiology, Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.; Bloemers FW; Department of Surgery, Amsterdam University Medical Center, Location VUmc, de Boelelaan 1117, Amsterdam, The Netherlands.; Van Lieshout EMM; Trauma Research Unit Dept. of Surgery, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, The Netherlands.; Den Hartog D; Trauma Research Unit Dept. of Surgery, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, The Netherlands.; Hoogerwerf N; Department of Anesthesiology, Radboud Unversity Medical Center, Geert Grooteplein Zuid 10, Nijmegen, The Netherlands.; Helicopter Emergency Medical Service Lifeliner 3, Zeelandsedijk 10, Volkel, The Netherlands.; van der Naalt J; Department of Neurology, University Medical Center Groningen, Hanzeplein 1, Groningen, The Netherlands.; Absalom AR; Department of Anesthesiology, University Medical Center Groningen, Hanzeplein 1, Groningen, The Netherlands.; Schwarte LA; Department of Anesthesiology, Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.; Helicopter Emergency Medical Service Lifeliner 1, De Boelelaan 1117, Amsterdam, The Netherlands.; Twisk JWR; Department of Epidemiology and Biostatistics, Amsterdam University Medical Center, De Boelelaan 1089a, Amsterdam, The Netherlands.; Schober P; Department of Anesthesiology, Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.; Helicopter Emergency Medical Service Lifeliner 1, De Boelelaan 1117, Amsterdam, The Netherlands.
Source
Publisher: Springer Verlag Country of Publication: United States NLM ID: 7704851 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-1238 (Electronic) Linking ISSN: 03424642 NLM ISO Abbreviation: Intensive Care Med Subsets: MEDLINE
Subject
Language
English
Abstract
Purpose: Severe traumatic brain injury is a leading cause of mortality and morbidity, and these patients are frequently intubated in the prehospital setting. Cerebral perfusion and intracranial pressure are influenced by the arterial partial pressure of CO 2 and derangements might induce further brain damage. We investigated which lower and upper limits of prehospital end-tidal CO 2 levels are associated with increased mortality in patients with severe traumatic brain injury.
Methods: The BRAIN-PROTECT study is an observational multicenter study. Patients with severe traumatic brain injury, treated by Dutch Helicopter Emergency Medical Services between February 2012 and December 2017, were included. Follow-up continued for 1 year after inclusion. End-tidal CO2 levels were measured during prehospital care and their association with 30-day mortality was analyzed with multivariable logistic regression.
Results: A total of 1776 patients were eligible for analysis. An L-shaped association between end-tidal CO2 levels and 30-day mortality was observed (p = 0.01), with a sharp increase in mortality with values below 35 mmHg. End-tidal CO 2 values between 35 and 45 mmHg were associated with better survival rates compared to < 35 mmHg. No association between hypercapnia and mortality was observed. The odds ratio for the association between hypocapnia (< 35 mmHg) and mortality was 1.89 (95% CI 1.53-2.34, p < 0.001) and for hypercapnia (≥ 45 mmHg) 0.83 (0.62-1.11, p = 0.212).
Conclusion: A safe zone of 35-45 mmHg for end-tidal CO2 guidance seems reasonable during prehospital care. Particularly, end-tidal partial pressures of less than 35 mmHg were associated with a significantly increased mortality.
(© 2023. The Author(s).)
Methods: The BRAIN-PROTECT study is an observational multicenter study. Patients with severe traumatic brain injury, treated by Dutch Helicopter Emergency Medical Services between February 2012 and December 2017, were included. Follow-up continued for 1 year after inclusion. End-tidal CO
Results: A total of 1776 patients were eligible for analysis. An L-shaped association between end-tidal CO
Conclusion: A safe zone of 35-45 mmHg for end-tidal CO
(© 2023. The Author(s).)