Management of arterial partial pressure of carbon dioxide in the first week after traumatic brain injury: results from the CENTER-TBI study

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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00134-021-06470-7.