About the quality of prehospital emergency ventilation - a prospective study in trauma patients

Introduction: The prehospitaly initiated endotracheal intubation and contro lled ventilation, is especially in multi-system-trauma cases, recognized to be the "gold standard". Thus especially in view of the increasing demands being placed upon the quality of prehospital emergency treatment in general , the quality of such prehospital induced ventilation, is becoming of incre asing importance, Thereby we must take into consideration the limited possa bilities, which are afflicted with a high degree of uncertainess, which we have at our disposal to effectively evaluate the efficiency of emergency ve ntilation. The purpose of our study within a collective of severely traumat ized patients, was to determine the quality of prehospitaly induced ventila tion with regards to the adequacy of oxygenation and ventilation and as a r esult of our findings, to identify areas for procedural optimization. Resul ts: The prospective study over an one year period involved n = 104 trauma c ases (male:79; female: 25/age: 39,8 +/- 20,8 years/ISS: 28,1 +/- 15,3) whos e prehospital emergency treatment required and included endotracheal intuba tion and controlled ventilation. All patients were subject to a prehospital pulse oxymetric monitoring, whereas none were subject to an objectivating apparatus monitoring of ventilation: 94,2 % of the patients were upon admis sion adequately oxygenated (paO(2) > 80 mmHg); only one patient was hypoxem ic (paO(2) < 60 mmHg). 46,2 % were adequately ventilated (paCO(2): 35-45 mm Hg), 43,2% however were hyperventilated (paCO(2) < 35 mmHg), and 10,6% hypo ventilated (paCO(2) > 45 mmHg). A statistical significant relation between hyper-/hypoventilation and the degree of severity of trauma as well as to t he individual injury pattern was not evident. However with reference to age : The group of > 60 years of age were significantly more frequently hyperve ntilated (paCO(2) < 30 mmHg: 31,2 %; p < 0,05). A noteworthy accumulation o f hypoventilation was experienced amongst the group of patients, who during the prehospital treatment phase were hemodynamic instable (shock index > 1 ).