engleski

The importance of jugular bulb oximetry for appropriate setting of ventilator in patients with severe head injury

Mechanical hyperventilation is widely used in patients with severe head injury during last twenty years. Hyperventilation to PaCO2 of 20 mmHg showed to have detrimental effect on the outcome in one randomized trial. The use of continous jugular bulb oximetry demonstrated a great number of desaturations associated with poor outcome. In this study hypocarbia was the most common single systemic cause of desaturation. In our previous study we demonstrated that even inttermitent measurments of SjO2. resulted in better ventilator settings. The objective of this study was the evaluation of continous SjO2 monitoring on optimal ventilator setting in severe head injury patients. Methods: 17 patients with severe head injury were included in the study (Glasgow Coma Scale score 3-8). All the patients were mechanicaly hyperventilated to PaCO2 of about 30 mmHg. Continus sedation and analgesia, using midazolam and fentanyl and intermittent relaxation using pancuronium was performed. Continuous monitoring of ICP (using Leeds boult, or Codman MicroSensor ICP transducer), arterial pressure, endexpiratory CO2 and pulse oximetry (RGM 5250 Ohmeda) was starded as soon as possible. Continuous monitoring of SjO2 was performed with Opticath 4F catheter and Oximetric 3 System (Abbott). All patients included in the study had cerebral perfusion pressure of at least 60 mmHg and ICP not higher than 20 mmHg. During the monitoring no periods of hypoxia or/and anemia were recorded. Duration of SjO2 monitoring was between five and thirdteen days. Ventilator settings were ajusted in order to keep SjO2 above 55%.

Severe head injury; jugular bulb oximetry; mech. ventilation

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