Abstract
ABSTRACT Introduction. Hypoxia is one of the secondary insults and it worsens the outcome in patients with severe traumatic brain injury (TBI). On the other hand, there is some controversy about the impact of hyperoxia on the outcome in these patients. The aim of the study was to determine the impact of pre-hospital hypoxia, hyperoxia and pre-hospital ventilation status on outcome after isolated TBI.Methods. We retrospectively reviewed charts from patients with isolated severe TBI who underwent pre-hospital endotra-cheal intubation. The population was sorted into groups based on PaO2 (hypoxic, PaO2 200 mmHg) and initial Glasgow Coma Scale (GCS) level (3-5 and ≥ 6). Ventilation status was defined as: hypocarbic (PaCO2 45 mmHg). Results. Oxygenation status had no significant impact on 24- and 48-hour survival, on the length of hospital stay or on neuro-logical outcome (measured by the Glasgow Outcome Scale (GOS), Glasgow Pittsburgh Cerebral Performance Categories Scale (CPC), and GCS score at discharge) when all six groups were compared together. We were unable to prove a dele-terious effect of hypoxia or hyperoxia compared to normoxia on rate of survival to hospital discharge (STHD) (0.38 (0.52) vs 0.50 (0.51) vs 0.65 (0.49), where 0 - no and 1 - yes; f = 1.246, p = 0.298). Ventilation status also failed to significantly af fect survival and functional outcome in patients with isolated severe TBI.Conclusion. Pre-hospital oxygenation and ventilation status have no significant impact on outcome in patients with isolated severe TBI.
Highlights
Hypoxia is one of the secondary insults and it worsens the outcome in patients with severe traumatic brain injury (TBI)
We were unable to prove a deleterious effect of hypoxia or hyperoxia compared to normoxia on rate of survival to hospital discharge (STHD) (0.38 (0.52) vs 0.50 (0.51) vs 0.65 (0.49), where 0 - no and 1 - yes; f = 1.246, p = 0.298)
In most of these studies pre-hospital intubation was performed by non-physician prehospital personnel with limited Endotracheal intubation (ETI) training and clinical skills and who did not have full access to the drugs used during rapid sequence intubation (RSI) protocol. [7,8,20,21] It is likely that the patients who can be intubated in the field without RSI medications have a more devastating neurologic injury compared to those who need RSI medications and as a consequence less favorourable outcome
Summary
Hypoxia is one of the secondary insults and it worsens the outcome in patients with severe traumatic brain injury (TBI). There is some controversy about the impact of hyperoxia on the outcome in these patients. The aim of the study was to determine the impact of pre-hospital hypoxia, hyperoxia and pre-hospital ventilation status on outcome after isolated TBI. Ventilation status failed to significantly affect survival and functional outcome in patients with isolated severe TBI. Pre-hospital oxygenation and ventilation status have no significant impact on outcome in patients with isolated severe TBI. Endotracheal intubation (ETI) using a rapid sequence intubation (RSI) protocol was introduced to pre-hospital Emergency Medical Services (EMS) to avoid hypoxia and to secure the airway, preventing aspiration in patients with TBI. Aggressive early airway management increases the success of pre-hospital ETI, but surprisingly increases the mortality rate. [7,8] The suggested causes for this finding are hyperventilation [9] and positive pressure ventilation; [10] both
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