Arterio-jugular difference of oxygen content and outcome after head injury.
This study investigated AJDO2 (arterio-jugular difference of oxygen content) in a large sample of severely head-injured patients to identify its pattern during the first days after injury and to describe the relationship of AJDO2 with acute neurological severity and with outcome 6 mo after trauma. In 229 comatose head-injured patients, we monitored intracranial pressure, cerebral perfusion pressure, and AJDO2. Outcome was defined 6 mo after injury. Jugular hemoglobin oxygen saturation (SjO2) averaged 68%. The mean AJDO2 was 4.24 vol% (SD, 1.3 vol%). There were 80 measurements (4.6%) with SjO2 <55% and 304 (17.6%) with saturation >75%. AJDO2 was higher than 8.7 vol% in 8 measurements (0.4%) and was lower than 3.9 vol% in 718 (42%) measurements. AJDO2 was higher during the first tests and decreased steadily over the next few days. Cases with a favorable outcome had a higher mean AJDO2 (4.3 vol%; SD, 0.3 vol%) than patients with severe disability or vegetative status (3.8 vol%; SD, 1.3 vol%) and patients who died (3.6 vol%; SD, 1 vol%). This difference was significant (P < 0.001). We conclude that low levels of AJDO2 are correlated with a poor prognosis, whereas normal or high levels of AJDO2 are predictive of better results.
Istituto Anestesia e Rianimazione, Università di Milano, Terapia Intensiva Neuroscienze, Ospedale Maggiore Policlinico, Istituto Ricovero e Cura a Carattere Scientifico, Milan, Italy.
Nino
N
Stocchetti
Katia
K
Canavesi
Sandra
S
Magnoni
Valerio
V
Valeriani
Valeria
V
Conte
Sandra
S
Rossi
Luca
L
Longhi
Elisa Roncati
ER
Zanier
Angelo
A
Colombo
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001923:Brain Chemistry / Q000502:physiology; D002245:Carbon Dioxide / Q000097:blood; D002560:Cerebrovascular Circulation / Q000502:physiology; D006259:Craniocerebral Trauma / Q000097:blood* / Q000628:therapy*; D005260:Female; D015600:Glasgow Coma Scale; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007601:Jugular Veins / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D010101:Oxygen Consumption / Q000502:physiology; D011379:Prognosis; D016896:Treatment Outcome
D006454:Hemoglobins; D002245:Carbon Dioxide; D010100:Oxygen