Blood gas, arterial, and end-tidal carbon dioxide in traumatic brain injury
Journal
Cellular, Molecular, Physiological, and Behavioral Aspects of Traumatic Brain Injury
ISBN
9780128230367
Date Issued
2022-01-01
Author(s)
Abstract
Managing arterial partial pressure of carbon dioxide (PaCO2) is a critical component in severe traumatic brain injury (TBI) care; current guidelines recommend maintaining normoventilation (PaCO2 35-45mmHg) and advise against prolonged prophylactic hyperventilation except for reversing brain herniation. While arterial blood sampling remains the gold standard, end-tidal carbon dioxide (EtCO2) monitoring is a noninvasive surrogate measurement used to estimate PaCO2 values. In acute TBI care setting, data generally showed only moderate correlation between PaCO2 and EtCO2 and agreement < 50% (defined as PaCO2-EtCO2 ≤ 5 or 6mmHg). Several concurrent conditions leading to V/Q mismatching were identified to further undermine the reliability of EtCO2 as a PaCO2 surrogate, such as severe chest trauma, hypotension, and pediatric acute respiratory distress syndrome. Transcutaneous partial pressure of carbon dioxide (PtcCO2) monitoring is another proposed surrogate for PaCO2; its application in adult severe TBI did not show superiority over EtCO2 monitoring. More research is warranted to evaluate the utility of PtcCO2 monitoring in severe TBI care.
Subjects
Brain Trauma Foundation guidelines | Cerebral blood flow regulation | Cerebrovascular CO reactivity 2 | End-tidal carbon dioxide (EtCO ) monitoring 2 | PaCO -EtCO agreement 2 2 | PaCO -EtCO correlation 2 2 | Pre-hospital management | Transcutaneous partial pressure of carbon dioxide (PtcCO ) monitoring 2 | Traumatic brain injury
Type
book part