Do trauma patients on ventilators in the emergency department need multiple blood gas analysis to optimize treatment?
- MS Moeng1
© Moeng; licensee BioMed Central Ltd. 2009
Published: 13 March 2009
The importance of adequate ventilatory support after severe trauma is highly stressed. However, this may lead to a tendency to hyperventilate trauma patients  put on a ventilator in the emergency department. The aim of this study was to investigate whether trauma patients on ventilator in the emergency department are hyperventilated.
A prospective collection of data for trauma patients put on a ventilator in the emergency department. The questionnaire included demographic information, indication for ventilation, analysis on initial and repeat arterial blood gases, and management changes. Patients were recruited over a period of 6 months from 1 November 2006 to 30 April 2007.
Fifty-nine patients were identified, 54 (91.5%) were male and five (8.5%) were female. Age ranged from 4 to 60 years. The indication for ventilator treatment was isolated head injury in 28 (47.5%) patients, polytrauma in 13 (22%) patients, polytrauma with severe head injury in nine (15.3%) patients and isolated airway and ventilation indication in the remaining nine (15.3%) patients. Thirty-seven patients had a Glasgow coma scale (GCS) of 3 to 8, 13 had GCS of 9 to 12, and nine patients had GCS of 13 to 15. The first arterial blood gas was done within 10 minutes of ventilator treatment in 48 (81%) of the cases, whereas the second was done within 90 minutes in 41 (69.5%) of the cases. In 23 (39%) patients, pCO2 was less than 30 mmHg on the first gas, and in 19 (32%) patients on the second gas. Oxygenation was adequate with levels above 200 mmHg in 40 (68%) of initial and in 47 (80%) of second gases. The most common ventilatory manipulation was a reduction in minute volume after the first gas in 14 (24%). Reduction of inspiratory oxygen was the most common change after the second gas in 28 (47%). The number of cases that should have had ventilatory adjustment was reduced from 12 (20%) after the first arterial blood gas to one (1.7%) after the second.
Although there was a tendency to hyperventilate patients on ventilators in the emergency department in our institution, satisfactory ventilation was achieved almost uniformly after the second blood gas analysis.