Incidence of intracranial hypertension related to jugular bulb oxygen saturation disturbances in severe traumatic brain injury patients

Objective. To analyze the Intracranial Hypertension (IH) development related to jugular bulb oxygen saturation (SjO(2)) disturbances in severe traumatic brain injury patients (sTBI). Materials and Methods. One hundred and thirty-five sTBI patients were reviewed. Those without IH at admission (n = 116) were included. All patients underwent ICP and SjO(2) continuous monitoring. Two groups were distinguished according to the SjO(2) values during the first 24 hours. Group A: those with abnormal SjO(2) (SjO(2) more than 75% or less than 55%) and Group B: those with normal SjO(2) (55-75%). Differences in IH development and outcome between groups were analyzed. Causes of abnormally low SjO(2) were identified. Results. IH developed in 56,9% of patients, between 12 and 48 hours from admission. Group A had a significantly higher incidence of IH than Group B (p < 0.001) and it also had a worse outcome than Group B (GOS 1-2) (p < 0.005). Patients from Group A had a risk of IH 4.5 fold higher than Group B. Considering only patients who developed IH, an abnormal SjO(2) value increased 2.3 fold the risk of death compared to those without SjO(2) disturbances. Main causes of SjO(2) desaturation were hyperventilation (40.7%), hypovolemia (28.4%) and anemia (21%). Conclusions. Early detection of disturbances in oxygen supply-demand relationship and prevention or resolution of the secondary insults which produce these disturbances, might lead to a reduction in the incidence of intracranial hypertension.