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Correlation Between Cerebral Venous-Arterial Pco2 Difference With Jugular Venous Oxygen Saturation As Global Cerebral Ischemia in Severe Traumatic Brain Injury
Intensive Care Medicine Experimental volume 3, Article number: A492 (2015)
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.
The goal of this study was to compare the correlation between VADpCO2 and SjVO2 on the assessment global cerebral ischemia in severe TBI.
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.
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)
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.
This study did not receive any grant from any funding agency.
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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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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). https://doi.org/10.1186/2197-425X-3-S1-A492
- Intensive Care Unit
- Traumatic Brain Injury
- Cerebral Blood Flow
- Glasgow Coma Scale
- Severe Traumatic Brain Injury