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Vol. 9. Issue 3.
Pages 232-236 (January 1998)
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Vol. 9. Issue 3.
Pages 232-236 (January 1998)
Utilidad clínica de la monitorización de la saturación de oxígeno en el bulbo de la yugular en los pacientes con traumatismo craneoencefálico grave
Clinical usefulness of jugular bulb oxygen saturation monitoring in severe head injury patients
A.J. Betbesé Roig, M. Pérez Márquez, L. Marruecos Sant, E. Bak, G. Rialp Cervera, J. Ballús Noguera, A. Net Castel
Servicio de Medicina Intensiva. Hospital de la Santa Creu i Sant Pau. Universidad Autónoma de Barcelona. Barcelona
I. Gich*
* Instituto de Investigación. Hospital de la Santa Creu i Sant Pau. Universidad Autónoma de Barcelona. Barcelona
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Resumen
Objetivo

Valorar la relación de la saturación de oxígeno en el bulbo de la vena yugular (SatY O2) con las imágenes obtenidas en la tomografía computarizada (TC) cerebral y con la mortalidad de los pacientes con traumatismo craneoencefálico (TCE) grave atendidos en nuestro Servicio de Cuidados Intensivos generales.

Pacientes y método

Estudiamos 28 pacientes con TCE grave (Glasgow Coma Score 6±2 a su ingreso). Se objetivó la SatY O2 y el índice oxígeno-lactato mediante la colocación de un catéter convencional en el bulbo de una vena yugular. Las lesiones objetivadas por la TC cerebral se clasificaron en difusas, focales o mixtas.

Resultados

Se obtuvieron un total de 282 determinaciones analíticas de la sangre del bulbo de la vena yugular que permitieron clasificar la situación hemodinámica cerebral (HC) como hiperemia, normalidad, hipoperfusión o isquemia global. En los pacientes que no fallecieron (NF) se obtuvo un 81% de mediciones de SatY O2 dentro de la normalidad, mientras que sólo la presentaron un 19% de los que fallecieron (F) (P: 0,007). No observamos relación entre la SatY O2, con las lesiones objetivadas por la TC con la clasificación utilizada.

Conclusiones

La monitorización de la SatY O2 se correlaciona con la mortalidad en el paciente con TCE grave. No observamos correlación entre las variables hemodinámicas cerebrales estudiadas con la TC.

Palabras clave:
Presión de perfusión cerebral, presión intracraneal
Bulbo yugular
Hiperventilación
Acoplamiento metabólico
Hipoperfusión
Abstract
Objective

To study the relationship between the oxygen saturation measured at the jugular bulb (SatY O2) with cerebral computerized tomography (CT) findings and mortality in severe head injury patients.

Material and methods

We studied 28 severe head injury patients (Glasgow Coma Score: 6±2 at admission). SatY O2 and lactate-oxygen index were measured through a conventional catheter implanted at one jugular bulbo CT brain injuries were classified as diffuse, focal or mixed.

Results

We performed 282 analytic determinations of jugular blood samples and classified the hemodynamis status as hyperemic, normal, hypoperfusion and ischemic. 81% of the survivors had SatY O2 value within normal limits in comparison to only 19% of patients who died (p<0.007). However, there was no a significant correlation between SatY O2 values and the CT findings.

Conclusion

Oxigen saturation measured at the yugular bulb correlated with mortality rate in severe head injury patients but the different hemodynamic patteros did not associate with the intracranial pathology an estimated by CT sean.

Key words:
Cerebral perfusion pressure
Intracranial pressure
Jugular bulb
Hyperventilation
Metabolic coupling
Hypoperfusion

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