TBI O2 Protocol

Question 1

When will patients considered to have severe TBI? (3)

Answer 1

1. GCS<8
2. There are no extra cranial factors attributing to patients neurological degen
3. No congenital or degenerative conditions or operative lesions present

**Pts with GCS >9 but have abnormal CT may be included

Question 2

TBI protocol goals?

Answer 2

Avoid hypoxemia desats and hypoxemia are associated with secondary brain injury

• PaO2 < 65 needs 100% FiO2 increase
• FiO2 > 60% needs MD discussion in PEEP increase

Question 3

How much should PEEP be increased by in TBI protocol if indicated by FIO2 requirements > 60%?

Answer 3

2-3cmH2O after MD consult

• PEEP 15 and FiO2 > 60% another solution needs to be discussed with MD
• LVRM may be considered

Question 4

TBI O2 protocol weaning discontinuation is determined by what factors?

Answer 4

• Increased ICP or decreased CPP
• HR > 140 or 20% change from baseline
• rise or fall of systolic BP to <90 or >180 that occurs with FiO2 adjustment
• ECG change
• Clinical signs/symptoms of hypoxia
• Hgb < 70

Question 5

What are signs and symptoms of hypoxia?

Answer 5

Tachypnea, Dyspnea, cyanosis, diaphoresis, confusion, or chest pain

Question 6

Management of severe TBI?

Answer 6

• PaO2 = 80-120 and SpO2 > 95%
• Tier 1 = PaCO2 35-40
• Tier 2 = PaCO2 30-34
• ICP < 20
• LICOX > 20

Question 7

What does LICOX measure?

Answer 7

Intracranial oxygenation and is used to indicate the perfusion status of cerebral tissue

Question 8

What does low CO2 cause in the brain?

Answer 8

Vasoconstriction and can cause brain tissue ischemia

Question 9

What does high CO2 cause in the brain?

Answer 9

Vasodilation and increase ICP and hemorrhage

Question 10

In the lungs, what does high CO2 cause?

Answer 10

Vasoconstriction in order to redirect blood flow, which increases resistance