Cerebral oxygenation and systemic trauma related factors determining neurological outcome after brain injury.
We examined the relationship between clinical and radiological findings, cerebral oxygenation patterns during intensive care management, presence of systemic trauma related injuries and severity of illness in 50 patients (age: 32.3 +/- 12 years, GCS: 8 +/- 4) who were rescued from the accident scene within a 30 min period after trauma. Presence of systemic injuries was quantified using the Injury Severity Score (ISS) and severity of illness was scored using the Acute Physiology and Chronic Health Evaluation (APACHE II). Cerebral oxygenation parameters included continuous monitoring of jugular bulb oxygen saturation (SjvO(2)) for 12 840 h, and 2323 periodical blood sampling for measurement of arteriovenous differences in oxygen content (AVDO(2)), arteriovenous difference of lactate (AVDL) and lactate oxygen index (LOI). Fifteen patients (30%) presented with anisocoria or non-reacting pupils. Diffuse lesions on computed tomography (CT) were found in 34% of the patients and in 66% a mass lesion was removed. The mean ISS was 28 +/- 15.3 and 34 patients (68%) had an APACHE II score between 20 and 29 (mean 24 +/- 15). No statistically significant association between age (P = 0.45), gender (P = 0.83), initial Glasgow Coma Score (GCS) (P = 0.43), episodes of cerebral perfusion pressure (CPP) < 70 mm Hg (P = 0.8), ISS (P = 0.28), pupillary abnormalities (P = 0.57), initial CT findings (P = 0.74), APACHE II scores (P = 0. 36) and outcome could be demonstrated. The number of SjvO(2)desaturations (< 60%) was the only statistically significant factor associated with outcome (P = 0.05). The percentage of patients with poor neurological outcomes (GOS 1-3) was 38% in patients with no or one desaturation episode, and 57.6% in those with multiple desaturations. In conclusion, in patients who are resuscitated early and quickly transferred to the hospital, the number of SjvO(2)desaturations during intensive care management might be associated with outcome more strongly than other clinical and radiological features.
Fandino
J
J
Department of Neurosurgery, Division of Trauma, University Hospital Zurich, Switzerland. fandino@nch.unizh.ch
Stocker
R
R
Prokop
S
S
Trentz
O
O
Imhof
H G
HG
D018806:APACHE; D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000097:blood* / Q000150:complications* / Q000503:physiopathology; D002406:Catheterization, Peripheral; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D002534:Hypoxia, Brain / Q000097:blood* / Q000209:etiology* / Q000503:physiopathology; D015601:Injury Severity Score; D007601:Jugular Veins; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010092:Oximetry / Q000379:methods; D010100:Oxygen / Q000097:blood*; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis
D019344:Lactic Acid; D010100:Oxygen