Introduction
Traumatic brain injury is a major cause of death in many
persons less than 45 years, and a high prevalence occurs in the male gender. It
is a non-degenerative injury that results in anatomical damage or the
functional impairment of the scalp, cranium, and meninges. The major causes
include traffic accidents, falls, aggressions, cold steel or major catastrophes
and sporting activities. The patients with the problems relating to the central
nervous system require ventilation support due to the acute respiratory failure
(ARF). The normal ventilation is an important therapeutic method for the
patients with severe head injuries. The other method is hyperventilation which
helps in cerebral vasoconstriction for intracranial pressure (ICP) control and
reversal of brain and cerebrospinal fluid (CSF) acidosis. The essay offers a
discussion of both methods taking the stand that normal ventilation is the
standard of care for the immediate management of traumatic head injuries in
many instances.
Position
The normal ventilation method is recognized as the
appropriate method of care for the initial management of a severe traumatic
brain injury. However, it is a challenge for the pre-hospital personnel to know
how to achieve the normal ventilation method especially when they use a bag and
mask. Thus, they ought to utilize the strategies that maximize oxygen delivery
and lower the inadequate ventilation. The goal of increasing the oxygen
delivery and lowering the inadequate ventilation is achieved by using the
ventilation rates that can avoid both hyperventilation and hypoventilation. The
main goal of the care providers should be to ensure adequate ventilation of the
patients. The guidelines for the use of the normal ventilation method are 12
breaths per minute for adult and 20 breaths per minute for a child eight years
of age. The rates are effective in maintaining adequate ventilation. The normal
method of ventilation aims to protect the airway thereby avoiding the damages
caused by hypoxemia and hypercapnia. By the issues raised, the normal
ventilation method can be a better method for managing the traumatic head
injuries.
Review
of Literature
A
review of the previous literature shows that normal ventilation is a standard
therapy for severe traumatic head injuries. It helps to prevent hypoxia which
is a condition of oxygen saturation less than 90% (Oddo, Levine, Mackenzie,
et.al. 2011). Early ventilation by use of the normal method supports breathing
and helps to keep the pressure low in the head. The process may involve the
mechanical placement of a device in the brain cavity to assess and regulate the
intracranial pressure (Chesnut, Temkin, Carne, et.al. 2012). There can be the
use of medications to put the patient in a drug induced coma that helps to
minimize agitation and secondary injury.
The compromise of the airway and the ventilator are
significant concerns after a traumatic brain injury. There is inadequate
research data to support an aggressive approach to the management of the airway
by personnel who performs the initial first aid. However, there are increasing
reports that articulate the association between an early intubation and
increased mortality (Maas, Menon, Lingsma, et. al., 2012). From research,
hyperventilation is a major contributor to adverse outcomes in the treatment of
the traumatic brain injuries. The approach of using hyperventilation against
the normal method is worsened by hemodynamic, cerebrovascular, immunologic and
cellular effects. The patients with severe TBI require mechanical ventilation
and not prophylactic hyperventilation for the first 24 hours of treatment
(Haddad & Arabi, 2012).
The use of hyperventilation tends to compromise the
critically reduced cerebral perfusion. For the patients with traumatic brain
injury, hyperventilation increases the volume of the severely hypoperfused
tissue in the damaged region of the brain. The occurrences are despite the
improvements in CPP and ICP. The reduced regional cerebral perfusions are a
representation of the regions of potential ischemic brain tissue. An excessive
and prolonged hyperventilation is likely to cause cerebral vasoconstriction and
ischemia (Haddad & Arabi, 2012). Thus, normal ventilation is more
appropriate for use than hyperventilation. The only instance it can work is as
a temporizing measure to reduce the elevated ICP (Arabi, Haddad, et al., 2010).
The requirement of the prolonged periods of hyperventilation may be during the
intracranial hypertension refractory to all treatments including sedation,
paralytics, CSF drainage, hypertonic saline solutions (HSSs) and osmotic
diuretics (Roberts, Hall, Kramer, et. al., 2011).
Mechanical ventilation helps to support gas exchange and
lung inflation in a normal method. It is a supportive and replacement therapy,
hence not a treatment method. The mechanical method replaces the normal
functions of the lungs and chest bellows. Thus, the many adverse effects of
intubation and positive-pressure ventilation require nurses to make the
ventilation period as short as possible.
Hyperventilation is a useful method in the management of
head trauma despite the other identified impacts. After a head injury, the
fluids can leak to the cranial vault thereby increasing the intracranial
pressure. The total cranial volume is usually fixed, and the brain is much more
compressible than the skull. Thus, with the increased intracranial pressure,
the brain is compressed and damaged. As a result, hyperventilation and cerebral
vasoconstriction help to reduce the volume of blood in the brain. A reduced
volume of blood in the cranial cavity results in the reduced pressure that
compresses the brain. However, the practice is not fully reliable since the
reduced blood flow to the brain may be a potential cause of ischemic damage
(Haddad, AlDawood, et.al. 2011).
Controversies
associated with the topic
There is controversy over whether or not patients with
traumatic brain injury should undergo hyperventilation. The major advantages of
hyperventilation are cerebral vasoconstriction for the intracranial pressure
(ICP) control and reversal of brain and cerebrospinal fluid (CSF) acidosis. The
likely disadvantages of the approach are cerebral vasoconstriction that may
cause cerebral ischemia and the short-lived impact on the PH of the
cerebrospinal fluid with a loss of HCO3-buffer. However, the disadvantage can
be addressed by the addition of buffer tromethamine (THAM), which has potential
experimental and clinical advantages (Rosenfeld, Maas, Bragge, et. al., 2012).
On the contrary, normal ventilation is a key component of intensive care for
the brain injuries, but unfamiliar and technical details make it confusing and
difficult for the care providers. The rapid complexity of the changes in
respiratory medicine escalates the problem. The current literature and all the
controversy in mechanical ventilation apply to a small percentage of patients
under intubation and ventilation in the care hospitals.
Some of the mechanical ventilation practices are invasive
that have contraindications. Thus, intubation and mechanical ventilations are
not appropriate for a circumstance with any indication of the ventilator
support, and when the interventions would result to medically futile therapy
(Pelosi, Ferguson, Frutos-Vivar, et.al. 2011). The premise that
hyperventilation therapy might cause secondary brain injury makes it unsuitable
as an initial method for the treatment of traumatic head injuries. However, the
approach can be effective to realize the required levels of gas within a short
period. Hyperventilation causes a decrease in cerebrospinal fluid without
necessarily reducing the pressure.
Application
in Medicine
In light of the information available about
hyperventilation as a treatment method, it is important for the medical
practitioners to make decisions based on the underlying impacts. The nervous
system controls the normal ventilation method for the management of traumatic
head injuries, both the depth and the frequency. The purpose is to maintain
normal amounts of carbon dioxide and also supply appropriate levels of oxygen
to the body tissues. An increase in the carbon dioxide levels in the blood
makes the brain blood vessels to dilate, but low carbon dioxide levels make the
vessels constrict that result to reduced blood flow to the brain (Spiotta,
Stiefel, et.al, 2010). The increase in blood PH is as a result of
hyperventilation that reduces the level of available calcium. The process
affects the nerves and muscles that cause constriction of the blood
vessels. However, for the head injury,
the management requires hyperventilation to reach carbon dioxide levels in the
blood in the range of 25 to 28 torr. The method is effective in reducing the
volume of blood in the cranial cavity thereby resulting in less pressure that
compresses the brain. For medical purposes, hyperventilation can be life-saving
in the treatment of acute intracranial hypertension. A prolonged
hyperventilation benefits patients with severe head injury or cerebral
infarction but with some consequences.
Conclusion
The treatment of head injuries may be done through the
two different methods of the closed or the penetrating head injury. There
exists a significant overlap between the treatments of the two types of injury,
but still there are certain differences. Most of the head injuries are mild,
but others are severe which requires a more comprehensive treatment method.
Hyperventilation method can be useful for short-term and usually after 24 hours
of treatment due to the associated adverse effects. On the other hand, the
normal ventilation method is appropriate for use due to the controversies
surrounding the use of hyperventilation. The medical practitioners have a role
to analyze the situations that arise and make informed decisions about the
method of treatment to adopt.
Bibliography
Arabi Y, Haddad S,
Tamim H, Al-Dawood A, Al-Qahtani S, Ferayan A. et al. (2010) Mortality Reduction after Implementing a Clinical
Practice Guidelines-Based Management Protocol
for Severe Traumatic Brain Injury. J Crit
Care; 25(2):190–195.
Chesnut, R. M., Temkin,
N., Carney, N., Dikmen, S., Rondina, C., Videtta, W., ... & Machamer, J. (2012). A trial of intracranial-pressure
monitoring in traumatic brain injury: New
England Journal of Medicine, 367(26),
2471-2481.
Haddad S, AlDawood AS,
AlFerayan A, Russell N, Tamim H, Arabi YM. (2011) The relationship between intracranial pressure monitoring and
outcomes in severe traumatic brain
injury patients: Anaesth Intensive Care.
2011; 39(6):1043–1050.
Haddad, S. H., &
Arabi, Y. M. (2012) Critical care management of severe traumatic brain injury in adults: Scand
J Trauma Resusc Emerg Med, 20(1), 12-27.
Sherry Roberts is the author of this paper. A senior editor at MeldaResearch.Com in custom nursing essay writing services services if you need a similar paper you can place your order for college essay writing services.
No comments:
Post a Comment