Article (Scientific journals)
Management of arterial partial pressure of carbon dioxide in the first week after traumatic brain injury: results from the CENTER-TBI study.
Citerio, Giuseppe; Robba, Chiara; Rebora, Paola et al.
2021In Intensive Care Medicine, 47 (9), p. 961-973
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Keywords :
142M471B3J (Carbon Dioxide); Brain; Brain Injuries, Traumatic/complications/therapy; Carbon Dioxide; Cohort Studies; Humans; Intracranial Pressure; Partial Pressure; Prospective Studies; Carbon dioxide; Hyperventilation; Intracranial pressure; Outcome; Traumatic brain injury
Abstract :
[en] PURPOSE: To describe the management of arterial partial pressure of carbon dioxide (PaCO(2)) in severe traumatic brain-injured (TBI) patients, and the optimal target of PaCO(2) in patients with high intracranial pressure (ICP). METHODS: Secondary analysis of CENTER-TBI, a multicentre, prospective, observational, cohort study. The primary aim was to describe current practice in PaCO(2) management during the first week of intensive care unit (ICU) after TBI, focusing on the lowest PaCO(2) values. We also assessed PaCO(2) management in patients with and without ICP monitoring (ICP(m)), and with and without intracranial hypertension. We evaluated the effect of profound hyperventilation (defined as PaCO(2) < 30 mmHg) on long-term outcome. RESULTS: We included 1100 patients, with a total of 11,791 measurements of PaCO(2) (5931 lowest and 5860 highest daily values). The mean (± SD) PaCO(2) was 38.9 (± 5.2) mmHg, and the mean minimum PaCO(2) was 35.2 (± 5.3) mmHg. Mean daily minimum PaCO(2) values were significantly lower in the ICP(m) group (34.5 vs 36.7 mmHg, p < 0.001). Daily PaCO(2) nadir was lower in patients with intracranial hypertension (33.8 vs 35.7 mmHg, p < 0.001). Considerable heterogeneity was observed between centers. Management in a centre using profound hyperventilation (HV) more frequently was not associated with increased 6 months mortality (OR = 1.06, 95% CI = 0.77-1.45, p value = 0.7166), or unfavourable neurological outcome (OR 1.12, 95% CI = 0.90-1.38, p value = 0.3138). CONCLUSIONS: Ventilation is manipulated differently among centers and in response to intracranial dynamics. PaCO(2) tends to be lower in patients with ICP monitoring, especially if ICP is increased. Being in a centre which more frequently uses profound hyperventilation does not affect patient outcomes.
Disciplines :
Human health sciences: Multidisciplinary, general & others
Author, co-author :
Citerio, Giuseppe ;  School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy.  ; Neurointensive Care Unit, Ospedale San Gerardo, Azienda Socio-Sanitaria Territoriale
Robba, Chiara;  Anesthesia and Intensive Care, Policlinico San Martino, IRCCS for Oncology and  ; Department of Surgical Science and Integrated Diagnostic, University of Genoa,
Rebora, Paola;  School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy. ; Bicocca Bioinformatics Biostatistics and Bioimaging Center B4, School of Medicine
Petrosino, Matteo;  Bicocca Bioinformatics Biostatistics and Bioimaging Center B4, School of Medicine
Rossi, Eleonora;  Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Unit of
Malgeri, Letterio;  Anesthesia and Intensive Care, School of Medicine, Messina, Italy.
Stocchetti, Nino;  Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy. ; Department of Physiopathology and Transplantation, Milan University, Milan, Italy.
Galimberti, Stefania;  School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy. ; Bicocca Bioinformatics Biostatistics and Bioimaging Center B4, School of Medicine
Menon, David K;  Neurocritical Care Unit, Addenbrooke's Hospital, Cambridge, UK.
Center-TBI participants and, investigators
Other collaborator :
Åkerlund, Cecilia
Amrein, Krisztina
Andelic, Nada
Andreassen, Lasse
Anke, Audny
Antoni, Anna
Audibert, Gérard
Azouvi, Philippe
Azzolini, Maria Luisa
Bartels, Ronald
Barzó, Pál
Koskinen, Lars-Owe
Kovács, Noémi
Kowark, Ana
Lagares, Alfonso
Lanyon, Linda
LAUREYS, Steven  ;  Centre Hospitalier Universitaire de Liège - CHU > > Centre du Cerveau²
Lecky, Fiona
LEDOUX, Didier  ;  Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs
Lefering, Rolf
Legrand, Valerie
Beauvais, Romuald
Lejeune, Aurelie
Levi, Leon
Lightfoot, Roger
Lingsma, Hester
Maas, Andrew I R
Castaño-León, Ana M
Maegele, Marc
Majdan, Marek
Manara, Alex
Manley, Geoffrey
Beer, Ronny
Martino, Costanza
Maréchal, Hugues
Mattern, Julia
McMahon, Catherine
Melegh, Béla
Menon, David
Menovsky, Tomas
Mikolic, Ana
Misset, Benoît ;  Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs
Muraleedharan, Visakh
Bellander, Bo-Michael
Murray, Lynnette
Negru, Ancuta
Nelson, David
Newcombe, Virginia
Nieboer, Daan
Nyirádi, József
Olubukola, Otesile
Oresic, Matej
Ortolano, Fabrizio
Palotie, Aarno
Belli, Antonio
Parizel, Paul M
Payen, Jean-François
Perera, Natascha
Perlbarg, Vincent
Persona, Paolo
Peul, Wilco
Piippo-Karjalainen, Anna
Pirinen, Matti
Pisica, Dana
Ples, Horia
Benali, Habib
Polinder, Suzanne
Pomposo, Inigo
Posti, Jussi P
Puybasset, Louis
Radoi, Andreea
Ragauskas, Arminas
Raj, Rahul
Rambadagalla, Malinka
Helmrich, Isabel Retel
Rhodes, Jonathan
Berardino, Maurizio
Richardson, Sylvia
Richter, Sophie
Ripatti, Samuli
Rocka, Saulius
Roe, Cecilie
Roise, Olav
Rosand, Jonathan
Rosenfeld, Jeffrey V
Rosenlund, Christina
Rosenthal, Guy
Beretta, Luigi
Rossaint, Rolf
Rossi, Sandra
Martin Rusnák, Daniel Rueckert
Sahuquillo, Juan
Sakowitz, Oliver
Sanchez-Porras, Renan
Sandor, Janos
Schäfer, Nadine
Schmidt, Silke
Schoechl, Herbert
Blaabjerg, Morten
Schoonman, Guus
Schou, Rico Frederik
Schwendenwein, Elisabeth
Sewalt, Charlie
Skandsen, Toril
Smielewski, Peter
Sorinola, Abayomi
Stamatakis, Emmanuel
Stanworth, Simon
Stevens, Robert
Bragge, Peter
Stewart, William
Steyerberg, Ewout W
Stocchetti, Nino
Sundström, Nina
Takala, Riikka
Tamás, Viktória
Tamosuitis, Tomas
Taylor, Mark Steven
Te Ao, Braden
Tenovuo, Olli
Brazinova, Alexandra
Theadom, Alice
Thomas, Matt
Tibboel, Dick
Timmers, Marjolein
Tolias, Christos
Trapani, Tony
Maria Tudora, Cristina
Unterberg, Andreas
Vajkoczy, Peter
Vallance, Shirley
Brinck, Vibeke
Valeinis, Egils
Vámos, Zoltán
van der Jagt, Mathieu
Van der Steen, Gregory
Naalt, Joukje van der
van Dijck, Jeroen T J M
van Essen, Thomas A
Van Hecke, Wim
van Heugten, Caroline
Van Praag, Dominique
Brooker, Joanne
van Veen, Ernest
Vyvere, Thijs Vande
van Wijk, Roel P J
Vargiolu, Alessia
Vega, Emmanuel
Velt, Kimberley
Verheyden, Jan
Vespa, Paul M
Vik, Anne
Vilcinis, Rimantas
Brorsson, Camilla
Volovici, Victor
von Steinbüchel, Nicole
Voormolen, Daphne
Vulekovic, Petar
K W Wang, Kevin K W
Wiegers, Eveline
Williams, Guy
Wilson, Lindsay
Winzeck, Stefan
Wolf, Stefan
Buki, Andras
Yang, Zhihui
Ylén, Peter
Younsi, Alexander
Zeiler, Frederick A
Zelinkova, Veronika
Ziverte, Agate
Zoerle, Tommaso
Bullinger, Monika
Cabeleira, Manuel
Caccioppola, Alessio
Calappi, Emiliana
Calvi, Maria Rosa
Cameron, Peter
Carbayo Lozano, Guillermo
Carbonara, Marco
Cavallo, Simona
Chevallard, Giorgio
Chieregato, Arturo
Citerio, Giuseppe
Clusmann, Hans
Coburn, Mark
Coles, Jonathan
Cooper, Jamie D
Correia, Marta
Čović, Amra
Curry, Nicola
Czeiter, Endre
Czosnyka, Marek
Dahyot-Fizelier, Claire
Dark, Paul
Dawes, Helen
De Keyser, Véronique ;  Université de Liège - ULiège > Département de Psychologie
Degos, Vincent
Della Corte, Francesco
den Boogert, Hugo
Depreitere, Bart
Đilvesi, Đula
Dixit, Abhishek
Donoghue, Emma
Dreier, Jens
Dulière, Guy-Loup
Ercole, Ari
Esser, Patrick
Ezer, Erzsébet
Fabricius, Martin
Feigin, Valery L
Foks, Kelly
Frisvold, Shirin
Furmanov, Alex
Gagliardo, Pablo
Galanaud, Damien
Gantner, Dashiell
Gao, Guoyi
George, Pradeep
GHUYSEN, Alexandre ;  Centre Hospitalier Universitaire de Liège - CHU > > Service des urgences
Giga, Lelde
Glocker, Ben
Golubovic, Jagoš
Gomez, Pedro A
Gratz, Johannes
Gravesteijn, Benjamin
Grossi, Francesca
Gruen, Russell L
Gupta, Deepak
Haagsma, Juanita A
Haitsma, Iain
Helbok, Raimund
Helseth, Eirik
Horton, Lindsay
Huijben, Jilske
Hutchinson, Peter J
Jacobs, Bram
Jankowski, Stefan
Jarrett, Mike
Jiang, Ji-Yao
Johnson, Faye
Jones, Kelly
Karan, Mladen
G Kolias, Angelos
Kompanje, Erwin
Kondziella, Daniel
Kornaropoulos, Evgenios
More authors (237 more) Less
Language :
English
Title :
Management of arterial partial pressure of carbon dioxide in the first week after traumatic brain injury: results from the CENTER-TBI study.
Publication date :
September 2021
Journal title :
Intensive Care Medicine
ISSN :
0342-4642
eISSN :
1432-1238
Publisher :
Springer, Heidelberg, United States - Delaware
Volume :
47
Issue :
9
Pages :
961-973
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
© 2021. The Author(s).
Available on ORBi :
since 27 March 2022

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