Inadequate respiratory support in head injury patients

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      Hyperventilation with 100% inspired oxygen is standard practice in victims of head trauma and is directed at both reduction of intracranial pressure and ensuring adequate oxygenation. Previous studies have established that medical care providers are inconsistent in maintaining respiratory rate and depth of ventilation with a bag valve device (BVD), producing both respiratory alkalosis and acidosis. A retrospective review of arterial blood gases of 160 trauma patients who were intubated and hyperventilated with BVD during transport from the scene or referring hospital revealed that 98.7% were adequately oxygenated on arrival in the emergency department (ED). Only 53.8% were both adequately oxygenated and appropriately hyperventilated. Inadequate hyperventilation (38%) and over-ventilation (6.9%) occurred more frequently than hypoxia unaccompanied by a ventilatory change (1.3%). The authors conclude that even with the most skilled of emergency care providers, inappropriate ventilation occurred in almost half (45%) of the patients with uncontrolled BVD ventilation during transport to the ED. Future studies are needed to explore alternative strategies that ensure prehospital ventilation.

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