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Volume 3 Supplement 1

ESICM LIVES 2015

Correlation Between Cerebral Venous-Arterial Pco2 Difference With Jugular Venous Oxygen Saturation As Global Cerebral Ischemia in Severe Traumatic Brain Injury

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Introduction

Traumatic Brain Injury (TBI) remains a leading cause of morbidity and disability and is considered a major public health concern. Ischemia is considered a relevant factor in TBI for prognosis, but its diagnosis in the early phases is still a problem. Now jugular venous oxygen saturation (SjVO2) is used to evaluate blood flow and cerebral metabolic rate as well as the cerebral venous-arterial pCO2 difference (VADpCO2) as a marker of low cerebral blood flow. Besides, there's no statement of VADpCO2 to guide medical therapy, consider as a not specific for global cerebral ischemia, but its observation over time may be useful.

Objectives

The goal of this study was to compare the correlation between VADpCO2 and SjVO2 on the assessment global cerebral ischemia in severe TBI.

Methods

This prospective observational, correlational study was conducted at the Intensive Care Unit Centro Médico Nacional del Bajío UMAE 1, in León Guanajuato, between August 2013 and December 2014. Patients were admitted in the intensive care unit after severe TBI, defined by an admission Glasgow Coma Scale < 8. We placed a catheter on right jugular bulb in all patients and corroborate the localization by X-Ray and CT-Scan. We took serial samples of jugular bulb catheter and arterial blood gases every 6 hours from admission or if the patient had a neurological worsening. the measurements of the SjVO2 were assessment in normal flow between 55-75%, high cerebral blood flow > 75% and low cerebral blood flow < 55%. the data were recorded such a VADpCO2 in each measurement.

Results

We included twenty-nine patients in the study, with a median age of 36 (interquartile range 24-56) years). One hundred and sixteen samples were taken. the distribution was 14.6% for low cerebral flow, 53.4% for normal cerebral flow and 31.8% for high cerebral flow. There was a statistically significant difference between the groups with VADpCO2 F (2,113)= 45.29, p= < 0.001. There was a change in the median of VADpCO2 in the different subgroups, SjVO2 < 55% (19.12 ± 5.08 mmHg), SjVO2 55 to 75% (8.94 ± 3.63mmHg) and SjVO2> 75% (8.3 ± 4.58 mmHg), with and alpha error of 0.05 (Figure 1), and moderately strong negative correlation between SjVO2 y VADpCO2 r=- 0.57 (Figure 2)

Figure 1
figure1

VADpCO 2 and cerebral blood flow.

Figure 2
figure2

Correlation between VADpCO 2 and SjO 2

Conclusions

There is a moderately strong correlation between SjVO2 and VADpCO2 that may be used for the correlation for global cerebral ischemia in the assessment of multimodality monitoring in neurocritical care in severe TBI.

Grant Acknowledgment

This study did not receive any grant from any funding agency.

References

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    Bor-Seng-Shu E, Kita WS, Figueiredo EG, Paiva WS, Fonoff ET, Teixeira MJ, et al: Cerebral hemodynamics: concepts of clinical importance. Arq Neuropsiquiatr. 2012, 70 (5): 357-365.

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    Wilensky EM, Gracias V, Itkin A, Hoffman K, Bloom S, Yang W, et al: Brain tissue oxygen and outcome after severe traumatic brain injury: a systemic review. Crit Care Med. 2009, 37 (6): 2057-2063. 10.1097/CCM.0b013e3181a009f8.

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Author information

Correspondence to E Gómez-Sandoval.

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Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0), which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Gómez-Sandoval, E., Hernandez-Flores, M., Soriano-Orozco, R. et al. Correlation Between Cerebral Venous-Arterial Pco2 Difference With Jugular Venous Oxygen Saturation As Global Cerebral Ischemia in Severe Traumatic Brain Injury. ICMx 3, A492 (2015) doi:10.1186/2197-425X-3-S1-A492

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Keywords

  • Intensive Care Unit
  • Traumatic Brain Injury
  • Cerebral Blood Flow
  • Glasgow Coma Scale
  • Severe Traumatic Brain Injury