Relationship between early patterns of cerebral extraction of oxygen and outcome from severe acute traumatic brain swelling: cerebral ischemia or cerebral viability?
Cruz, J.
Critical Care Medicine 24(6): 953-956
1996
ISSN/ISBN: 0090-3493 PMID: 8681597 Document Number: 459475
Objective: To evaluate outcome from severe acute traumatic diffuse brain swelling, in relation to early patterns of global cerebral extraction of oxygen. Design: Prospective, interventional study. Setting: Neuroscience intensive care unit of a university hospital. Patients: Adults (n = 205) with acute, essentially isolated brain trauma (predominantly diffuse brain swelling), undergoing routine early monitoring of cerebral extraction of oxygen and intracranial pressure, along with other monitoring modalities. Interventions: Routine neuroemergency procedures. Measurements and Main Results: Cerebral extraction of oxygen (arteriojugular oxyhemoglobin saturation difference) was measured in each patient, early in the acute phase (2 to 8 hrs postinjury). Outcome at 6 months postinjury was significantly better in patients with initially increased cerebral extraction of oxygen ( gt 42%) than in those patients with normal (24% to 42%) or decreased ( lt 24%) values. In contrast, no significant differences were found among these three groups with respect to age, initial Glasgow Coma Scale score, intracranial pressure, cerebral perfusion pressure, PaCO-2, total hemoglobin content, and time from injury when the initial measurements were performed. Conclusions: Initially increased cerebral extraction of oxygen appears to indicate global cerebral viability rather than cerebral ischemia in patients with acute traumatic diffuse brain swelling.