Measurement of cerebrovascular carbon dioxide reactivity using continuous jugular venous oxygen saturation monitoring in severe head injury.

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  • 重症頭部外傷における持続内頚静脈酸素飽和度測定を利用した脳血管二酸化炭素反応性の測定

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To investigate cerebral carbon dioxide (CO2) reactivity in head injured patients, continuous jugular venous oxygen saturation (SjO2) monitoring with a fiberoptic catheter (Opticath) was performed, and the validity of this method was also evaluated. Thirty-two patients with severe head injuries underwent continuous monitoring of SjO2 in the intensive care unit. Within 24 hours after head injury, CO2 reactivity was measured using ventilatory manipulation, and subsequent changes in SjO2 values were determined. The formula derived from Fick's principle was used to calculate the CO2 reactivity values. No catheter related complications were observed. In 12 patients, data showed a significant correlation between SjO2 values obtained by the catheter monitoring system and those measured by Co-oximeter (r2=0.932, p<0.0001). During ventilatory manipulation, changes in SjO2 were 5.8±3.4% and 8.3±2.7mmHg for arterial CO2 tension (PaCO2). CO2 reactivity was calculated at 1.75±1.16/mmHg of PaCO2. There was a significant correlation between patient outcome and CO2 reactivity value. Patients with favorable outcomes (p<0.0001) and with poor outcomes (p<0.0001) had higher reactivity values than those of deceased patients. Also a significant correlation was found between type of intracranial lesion and CO2 reactivity. Patients with diffuse lesions (p<0.05) had higher reactivity values than those with evacuated mass lesions. Furthermore, CO2 reactivity measured with SjO2 values on the monitor presented valid data in the clinical setting. The monitor provided clinical and prognostic information for the management of severe head injury without any significant difficulties.

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