Jugular venous oxygen saturation or arteriovenous difference of lactate content and outcome in children with severe traumatic brain injury.
OBJECTIVE
To assess the association between neurologic out-come and the alterations of jugular venous oxygen saturation (SjvO2) or the increase in arteriovenous difference of lactate content (AVDL) in children with severe traumatic brain injury.


METHODS
Observational prospective cohort study.


METHODS
Multidisciplinary pediatric intensive care unit of a university hospital.


METHODS
A total of 27 pediatric patients with severe traumatic brain injury, with a Glasgow Coma Scale after resuscitation of <9, who were admitted to the pediatric intensive care unit within 36 hrs after injury.


METHODS
Intermittent measurement of SjvO2 and AVDL.


RESULTS
SjvO2 and AVDL were assessed simultaneously every 6 hrs. The primary dependent variable measured was assessed independently 3 months after trauma according to the Pediatric Cerebral Performance Category. Patients were classified into two groups: group 1 (favorable outcome, Pediatric Cerebral Performance Category 1-3) and group 2 (unfavorable outcome, Pediatric Cerebral Performance Category 4-6); 81% were included in group 1 and 19% in group 2. A total of 354 measurements of SjvO2 and AVDL were made, with a mean of 13.1 +/- 7.9 per patient. The number of abnormal measurements of SjvO2 and increased AVDL used to predict the neurologic outcome was selected according to the area under the receiver operating characteristic curve. Mortality was 15% (four patients). The strongest association was found between a poor neurologic outcome and two or more pathologic AVDL measurements (higher than -0.37 mmol/L; relative risk, 17.6; 95% confidence interval, 2.5-112.5; p = .001). The presence of two or more measurements of SjvO2 of < or = 55% was significantly associated with a poor neurologic outcome (relative risk, 6.6; 95% confidence interval, 1.5-29.7; p = .003). The frequency of measurements of SjvO2 of > or = 75% was not different between groups 1 and 2.


CONCLUSIONS
In children with severe traumatic brain injury, two or more measurements of SjvO2 of < or = 55% or two or more pathologic AVDL measurements were associated with a poor neurologic outcome. Further studies are needed to recommend the use of these variables as a guideline to optimize treatment.
Pérez
Augusto
A
Pediatric Intensive Care Unit, Pediatric Neurosurgery Section, Hospital Italiano de Buenos Aires, Asociado a la Universidad de Buenos Aires, Buenos Aires, Argentina. caperez@intramed.net.ar
Minces
Pablo G
PG
Schnitzler
Eduardo J
EJ
Agosta
Guillermo E
GE
Medina
Santiago A Portillo
SA
Ciraolo
Carlos A
CA
D000293:Adolescent; D002405:Catheterization, Central Venous / Q000295:instrumentation; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000097:blood*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007427:Intracranial Pressure; D007601:Jugular Veins; D007773:Lactates / Q000097:blood*; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D017063:Outcome Assessment, Health Care; D010100:Oxygen / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve
D007773:Lactates; D010100:Oxygen