{
  "abstract": "A single episode of hypoxia, hypo- or hyperventilation, and/or hypotension can double morbidity and mortality after a severe traumatic brain injury (TBI), and proper initial manual ventilation at the point of injury and during initial evacuation is critical. In tactical combat casualty care (TCCC) Tier 2–4, manual bag-valve mask (BVM) ventilation is expected of non-medical personnel trained as a combat life saver (CLS) as well as medical personnel including combat medics/corpsmen (CMC) and combat paramedics/providers (CPP). Use of a BVM is considered part of basic care, but proper manual ventilation is extremely challenging. Civilian EMTs and paramedics hypo- and hyperventilate frequently, with very few providing the intended ventilation rate and volume. The harmful consequences after TBI are multifactorial. Hypoventilation leads to respiratory acidosis and contributes to global and cerebral hypoxia due to inadequate respiratory support for the casualty. Hyperventilation leads to hypocapnia-induced cerebral vasoconstriction and reduces cerebral blood flow and oxygen delivery. Additionally, increased rate and volume of ventilation increase intrathoracic pressure which can secondarily increase intracranial pressure; the increased intrathoracic pressure decreases venous return and, as a result, cardiac output, which will worsen any shock state.While mechanical ventilators are the current standard for intubated patients, every casualty that is mechanically ventilated at any echelon of care is manually ventilated first. Mechanical ventilators require technical expertise to be used properly, and the cost, size, and weight limit their use in tactical field care and during tactical evacuation. Mechanical ventilators may be a constrained resource in large scale combat operations and mass casualty events.Emerging solutions aim to address the critical issues of improper manual ventilation and establish contingencies for when mechanical ventilators, or trained medical providers, are not available (Figure). Capnography reflects respiratory rate and can indirectly inform overall ventilation but is unreliable in non-intubated patients and confounded by patients with shock and/or acidosis. Flow and pressure limiting devices do not prevent high tidal volumes and may contribute to hypoventilation; therapeutic hyperventilation in herniation syndromes is difficult. Current ventilation feedback devices provide quantitative tidal volume and respiratory rate information but are not ideal for the far-forward environment as they are integrated into large cardiac monitors, require recharging, and/or have multiple components required for use.The ideal device would be self-contained, small, lightweight, self-powered, able to be used in diverse clinical settings and scenarios, and intuitive in use and interpretation so that extensive training is not needed.Abstract P06 Figure 1Characteristics of existing and ideal technologies to prevent iatrogenic hyperventilation and hypoventilation in casualties with traumatic brain injury",
  "authors": [
    {
      "affiliations": [
        "Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH",
        "Rescue Ventilation Solutions, LLC, Cincinnati, OH"
      ],
      "name": "Jason McMullan"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH",
        "Rescue Ventilation Solutions, LLC, Cincinnati, OH"
      ],
      "name": "Justin Benoit"
    }
  ],
  "title": "P06 Strategies to prevent iatrogenic hyperventilation and hypoventilation in casualties with traumatic brain injury",
  "uid": "afd67ad1-8f8c-52e1-b5ac-79600f526639"
}