Usefulness of venous oxygen saturation in the jugular bulb for the diagnosis of brain death: report of 118 patients
| Autor: | Eduardo Miñambres, Segundo González-Herrera, Francisco López-Espadas, Carlos Garrido-Díaz, Genaro Díaz-Regañón, Marisol Holanda |
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| Rok vydání: | 2002 |
| Předmět: |
Male
medicine.medical_specialty Brain Death Neurological disorder Electroencephalography Critical Care and Intensive Care Medicine Sensitivity and Specificity law.invention law Predictive Value of Tests Anesthesiology medicine Humans Oximetry Prospective Studies medicine.diagnostic_test business.industry Apnea Venous blood Middle Aged medicine.disease Intensive care unit Polytrauma Oxygen Intensive Care Units Anesthesia Circulatory system Female medicine.symptom Jugular Veins business |
| Zdroj: | Intensive care medicine. 28(12) |
| ISSN: | 0342-4642 |
| Popis: | Objective. To assess the usefulness of venous oxygen saturation in the jugular bulb (SjO2) as a complementary test for the diagnosis of brain death. Design. Prospective observational study. Setting. Polytrauma intensive care unit (ICU) of an acute-care teaching hospital in Santander, Spain. Patients. We studied 118 (44%) out of 270 patients with severe head injury and intracranial hemorrhage meeting criteria of brain death (lack of cardiac response to atropine, unresponsive apnea, and iso-electric EEG in the absence of shock, hypotension and treatment with muscle relaxants and/or central nervous system (CNS) depressant drugs). Measurements and results. At the moment at which clinical diagnosis of brain death was made and an iso-electric EEG was obtained, simultaneous oxygen saturation in central venous blood (right atrium) (SvO2) and jugular venous bulb (SjO2) samples was measured. The ratio between SvO2 and SjO2, expressed as CvjO2 (the so-called central venous-jugular bulb oxygen saturation rate; CvjO2 = SvO2/SjO2) was calculated. CvjO2 less than 1 was obtained in 114 patients [mean (SD): 0.89 (0.02)], whereas CvjO2 greater than 1 was obtained in only 4 (3.38%). In the group of 152 survivors, a single patient was discharged from the ICU in a vegetative state in which CvjO2 was below 1. CvjO2 as a complementary test for the diagnosis of brain death showed 96.6% sensitivity, 99.3% specificity, and 99.1% and 97.4% positive and negative predictive values, respectively. Conclusion. Central venous-jugular bulb oxygen saturation rate below 1 together with accepted clinical criteria (unresponsive coma with brainstem areflexia) provides non-invasive assessment of cerebral circulatory arrest that can help to suspect brain death. |
| Databáze: | OpenAIRE |
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