Intervention Review

Hyperventilation therapy for acute traumatic brain injury

  1. Ian Roberts1,*,
  2. Gillian Schierhout2

Editorial Group: Cochrane Injuries Group

Published Online: 20 OCT 1997

Assessed as up-to-date: 6 JAN 2008

DOI: 10.1002/14651858.CD000566


How to Cite

Roberts I, Schierhout G. Hyperventilation therapy for acute traumatic brain injury. Cochrane Database of Systematic Reviews 1997, Issue 4. Art. No.: CD000566. DOI: 10.1002/14651858.CD000566.

Author Information

  1. 1

    London School of Hygiene & Tropical Medicine, Cochrane Injuries Group, London, UK

  2. 2

    London School of Hygiene & Tropical Medicine, c/o Cochrane Injuries Group, London, UK

*Ian Roberts, Cochrane Injuries Group, London School of Hygiene & Tropical Medicine, North Courtyard, Keppel Street, London, WC1E 7HT, UK. ian.roberts@lshtm.ac.uk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 20 OCT 1997

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Because hyperventilation is often associated with a rapid fall in intracranial pressure, it has been assumed to be effective in the treatment of severe head injury. Hyperventilation reduces raised intracranial pressure by causing cerebral vasoconstriction and a reduction in cerebral blood flow. Whether or not reduced cerebral blood flow improves neurological outcome is, however, unclear.

Objectives

To quantify the effect of hyperventilation on death and neurological disability following head injury.

Search methods

We searched the following electronic databases: the Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library 2007, Issue 4), MEDLINE, PubMed, EMBASE, PsycINFO. We searched the Internet, checked reference lists of relevant studies, and contacted the first author of eligible reports to ask for assistance in identifying any further trials. The searches were updated in January 2008.

Selection criteria

All randomised trials of hyperventilation, in which study participants had a clinically defined acute traumatic head injury of any severity. There were no language restrictions.

Data collection and analysis

We collected data on the participants, the timing and duration of the intervention, duration of follow-up, neurological disability and death. Relative risks (RR) and 95% confidence intervals (CI) were calculated for each trial on an intention-to-treat basis. Timing, degree and duration of hyperventilation were identified a-priori as potential sources of heterogeneity between trials.

Main results

One trial of 113 participants was identified. Hyperventilation alone, as well as in conjunction with a buffer (THAM [tris-hydroxy-methyl-amino methane]), showed a beneficial effect on mortality at one year after injury, although the effect measure was imprecise (RR 0.73; 95% CI 0.36 to 1.49, and RR 0.89; 95% CI 0.47 to 1.72 respectively). This improvement in outcome was not supported by an improvement in neurological recovery. For hyperventilation alone, the RR for death or severe disability was 1.14 (95% CI 0.82 to 1.58). The RR for death or severe disability in the hyperventilation-plus-THAM group was 0.87 (95% CI 0.58 to 1.28).

Authors' conclusions

The data available are inadequate to assess any potential benefit or harm that might result from hyperventilation in severe head injury. Randomised controlled trials to assess the effectiveness of hyperventilation therapy following severe head injury are needed.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Not enough evidence on whether hyperventilation therapy improves outcomes for people with traumatic brain injury

Traumatic brain injury is a major cause of premature death and disability. Severe head injury can trigger brain swelling, thereby increasing pressure on the brain (raised intracranial pressure, ICP). Raised ICP increases the likelihood of brain damage or death. Treatment to lower people's ICP commonly involves hyperventilation therapy (increasing blood oxygen levels) following the brain injury. While hyperventilation therapy can reduce ICP after traumatic brain injury, the review of trials found there is no strong evidence about whether this improves outcomes. More trials are needed.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

急性創傷性腦損傷的換氣過度治療

換氣過度通常可快速降低顱內壓,因而假設可以有效治療嚴重的頭部損傷。換氣過度使腦部血管收縮且減少腦血容積,因而降低過高的顱內壓。然而降低大腦血流是否能改善神經方面結果,則無法得知。

目標

量化換氣過度在腦損傷後之死亡和神經傷殘的影響

搜尋策略

我們使用預先設定的搜尋策略,搜尋Cochrane Injuries Group's specialised register、the Cochrane Central Register of Controlled Trials、MEDLINE、PubMed、EMBASE和NRR等之電子資料庫。 我們另經由網路搜尋,找出參考資料之相關研究,並與研究發表之第一作者聯繫,尋求協助確認是否有其他之研究。資料搜尋更新至2006年3月。

選擇標準

所有過度換氣隨機試驗研究之參與者,皆為臨床上界定急性創傷性頭部損傷者。研究之選取,不限制任何語文發表。

資料收集與分析

我們收集了參與者、時間、介入期間和後續追蹤期間,在神經學傷殘和死亡的資料數據。以相對風險(RR)和95%信賴區間(CI)計算每個試驗的意圖治療intentiontotreat。 當異質性來源出現在不同試驗時,以時間、換氣過度的程度和期間來辨認apriori。

主要結論

1個試驗包括113個參加者。 換氣過度單獨,以及併用緩衝劑(THAM [tris羥甲醇氨基甲烷一道]),雖然結果測量的項目不正確,但受傷一年以後死亡率顯示有利的結果,(分別為RR 0.73; 95% CI 0.36到1.49和RR 0.89; 95% CI 0.47到1.72)。intentiontotreat的結果不能由神經學補救的改善而獲得支持。換氣過度, 死亡或嚴厲傷殘RR是1.14 (95% CI 0.82到1.58)。 在換氣過度加上THAM小組,死亡或嚴厲傷殘RR是0.87 (95% CI 0.58到1.28)。

作者結論

可用的數據並無法評估換氣過度在嚴重頭部受傷可能的優缺點, 估計換氣過度療法的有效率性,嚴重頭部受傷的治療以隨機控制的實驗設計是需要的。

翻譯人

本摘要由高雄榮民總醫院陳淑梅翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有足夠的證據確認換氣過度療法是否改進腦損傷。腦損傷是夭折和傷殘的主因。 嚴重頭部受傷(上升的顱內的壓力, ICP)可能觸發腦膨脹,因此壓力增長。上升的ICP增加腦損傷或死亡可能性。 腦損傷時通常用換氣過度療法以降低ICP及增加血液氧氣成水平。 當換氣過度療法可能在創傷腦傷以後減少ICP,找到的試驗回顧裡是沒有強力的證據支持這項結論。 更多試驗是需要的。