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Management of Arterial Partial Pressure of Carbon Dioxide in the First Week after Traumatic Brain Injury: Results from the CENTER-TBI Study

By Currents Editor posted 15 days ago

  

Management of Arterial Partial Pressure of Carbon Dioxide in the First Week after Traumatic Brain Injury: Results from the CENTER-TBI Study

Intensive Care Medicine (07/24/21) DOI: 10.1007/s00134-021-06470-7

Citerio, Giuseppe; Robba, Chiara; Rebora, Paola; et al.

https://link.springer.com/article/10.1007%2Fs00134-021-06470-7 

A secondary analysis of data from the CENTER-TBI study found substantial practice variation among countries and centers in terms of arterial partial pressure of carbon dioxide (PaCO2) levels for patients in the first week after traumatic brain injury (TBI). Additionally, patients who received intracranial pressure monitoring (ICPm) were managed at lower PaCO2 compared with patients who did not receive ICPm. The analysis included 1,100 patients and 11,791 measurements of PaCO2. The mean PaCO2 measurement was 38.9 mmHg (± 5.2), while the mean minimum PaCO2 was 35.2 mmHg (± 5.3). At 34.5 vs. 36.7 mmHg, the mean daily minimum PaCO2 values were much lower in the ICPm group compared with the group without ICPm. The daily PaCO2 nadir was lower in patients with intracranial hypertension, at 33.8 vs. 35.7 mmHg. There was substantial heterogeneity between centers in targeting a PaCO2 of 35–45 mmHg; their means ranged from 32.3 (± 3.7) to 38.7 mmHg (± 5.9). The researchers also noted that management in a center using profound hyperventilation more often was not correlated with increased 6 months mortality or unfavorable neurological outcomes.

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