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首页> 外文期刊>The Internet Journal of Emergency and Intensive Care Medicine >Hyperventilation Patterns And The Outcome Of Traumatic Brain Injury In An Adult Intensive Care Unit
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Hyperventilation Patterns And The Outcome Of Traumatic Brain Injury In An Adult Intensive Care Unit

机译：成人重症监护病房过度换气的模式和创伤性脑损伤的结果

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Objective: To determine the patterns of hyperventilation and its effect on the outcome of adult intensive care patients with traumatic brain injuryMethods: A retrospective observational study was conducted in an adult intensive care unit (ICU) of a tertiary care University Hospital in Trinidad. Demographic data including age, sex, ethnicity and substance abuse were noted. Etiology, Glasgow Coma Scale (GCS) score on admission and discharge, length of stay, patterns and duration of hyperventilation and PaCO2 were recorded. Outcome of patients with a mean PaCO2 < 30 mmHg was compared with those with a mean PaCO2 ≥30 mmHg.Results: Of the 197 patients studied, 164 (83.2%) were male. The mean age was 41.3, mean length of stay was 10.4 days and mean GCS on admission was 6.3. Deliberate hyperventilation for 48 hours was planned in 35 % of patients. Factors such as age, length of stay, admission GCS, mean ICP, mean PaO2 and mean PaCO2 did not affect patient outcome. Mean PaCO2 and admission GCS were not good predictors of patient outcome. Kaplan-Meier survival curves showed that patients having PaCO2 > 30 mmHg had a higher survival at 30 days, but this was not statistically significant (p= 0.06).Conclusion: There was no improvement in the outcome of brain injury patients by deliberate hyperventilation to achieve lower levels of PaCO2. Introduction Head injury is associated with tremendous morbidity and mortality. The CRASH Trial which included data from 46 countries showed that head-injury is one of the leading causes of death and there was a significant difference in the outcome of head injury between the high income and low-middle income countries (1). In the UK, 1% of all deaths were attributed to head injury and up to 85% of all severely head injured patients have remained disabled after 1 year (2). In Trinidad & Tobago, 1% of admissions to Government hospitals and 2 out of 1000 deaths were due to head injuries (3). Trauma accounts for the majority of head injured patients admitted to tertiary care institutes and when severe, requires mechanical ventilation in an ICU environment. The overall mortality in severe traumatic brain injury, defined as a post resuscitation Glasgow Coma Scale score of ? 8, is 23 % (4). Traumatic brain injury has a devastating financial, emotional, and social impact on survivors left with lifelong disability as well as their families (5). Primary injury to the brain is irreversible; thus management of the head injured patient involves minimizing secondary brain injury. Hyperventilation has been a controversial, but fundamental principle in the management of these patients. Hyperventilation has been employed in the head injured patient due to the physiological mechanism of promoting cerebral vasoconstriction and thus reducing cerebral blood volume in an attempt to decrease intracranial pressure (6). However in recent times, studies have shown that prophylactic hyperventilation may do more harm than good. Some studies have shown that hyperventilation in the first 24 hours following head injury may cause reduction in cerebral blood flow at a time when flow is already decreased, compounding cerebral ischemia (7). While there is evidence to support the reduction in cerebral blood flow and increased areas of ischemic brain following hyperventilation, few studies report the effect of hyperventilation on clinical outcome. Although hyperventilation has remained a component of the management of the head injured patient for decades, it is now recommended to reserve its use for the patient with signs of impending brain herniation and to not employ hyperventilation routinely (8). Hyperventilation is still practiced routinely in the management of the head injured patient in Trinidad and Tobago. To our knowledge, there has been no published paper from the Caribbean evaluating the effect of hyperventilation on clinical outcome of head injury patients. With this background, this study was conducted to determine the effect o
机译：目的：确定过度通气的模式及其对成年重症脑损伤患者的治疗效果的影响方法：在特立尼达大学三级护理大学医院的成年重症监护室（ICU）进行回顾性观察研究。记录了人口统计数据，包括年龄，性别，种族和药物滥用。记录病因学，格拉斯哥昏迷量表（GCS）入院和出院分数，住院时间，过度换气的模式和持续时间以及PaCO2。将平均PaCO2 <30 mmHg的患者的结果与平均PaCO2≥30 mmHg的患者的结果进行比较。结果：在研究的197例患者中，有164例（83.2％）为男性。平均年龄为41.3，平均住院时间为10.4天，入院时平均GCS为6.3。计划对35％的患者进行故意的过度换气48小时。年龄，住院时间，入院GCS，平均ICP，平均PaO2和平均PaCO2等因素均不影响患者预后。平均PaCO2和入院GCS并不是患者预后的良好预测指标。 Kaplan-Meier生存曲线显示PaCO2> 30 mmHg的患者在30天时具有更高的生存率，但在统计学上无统计学意义（p = 0.06）。结论：故意通气过度使脑损伤患者的转归没有改善。达到较低的PaCO2水平。引言头部受伤与巨大的发病率和死亡率有关。包括来自46个国家/地区的数据在内的CRASH试验表明，头部受伤是主要的死亡原因之一，高收入国家和中低收入国家/地区的头部受伤结果存在显着差异（1）。在英国，所有死亡中有1％归因于头部受伤，并且在1年后，高达85％的严重头部受伤患者仍处于残疾状态（2）。在特立尼达和多巴哥，公立医院的入院率为1％，每千人中有2人死于头部受伤（3）。创伤占进入三级护理机构的头部受伤患者的大部分，严重时需要在ICU环境中进行机械通气。严重创伤性脑损伤的总体死亡率定义为复苏后格拉斯哥昏迷量表评分为？ 8是23％（4）。脑外伤对终身残疾的幸存者及其家人具有毁灭性的经济，情感和社会影响（5）。对大脑的原发性损伤是不可逆的;因此，对头部受伤患者的管理涉及将继发性脑损伤减至最小。换气过度一直是有争议的，但在这些患者的治疗中是基本原则。由于促进脑血管收缩从而减少脑血容量的生理机制，已在头部受伤的患者中使用了过度换气，以试图降低颅内压（6）。但是，近来的研究表明，预防性换气过度弊大于利。一些研究表明，头部受伤后的前24小时过度换气可能会导致脑血流量减少，而此时脑血流量已经减少，加剧了脑缺血（7）。尽管有证据支持过度换气后脑血流量的减少和缺血性脑区域的增加，但很少有研究报道过度换气对临床结局的影响。尽管通气过度一直是头部受伤患者管理的一个组成部分，但几十年来建议仍将其用于有脑疝症迹象的患者，并且不要常规使用过度通气（8）。在特立尼达和多巴哥，头部通气治疗仍是常规的过度换气。据我们所知，加勒比海地区还没有发表过有关过度换气对颅脑损伤患者临床疗效的影响的论文。在此背景下，本研究旨在确定

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