Monitoring of severely head-injured patients during the first 72 h: correlation with mortality

Introduction

Monitoring of severely head-injured and postoperative neurosurgical patients is essential to optimize cerebral hemodynamics and thus to minimize secondary injuries. We investigated the correlation between cerebral variables obtained in the first 72 h and survival.

Methods

This was a prospective study in 14 patients in a 24-bed adult ICU. After initial resuscitation, cerebral monitoring was performed and cerebral perfusion pressure (CPP) was increased to 70 mmHg by an increase in mean arterial pressure (MAP) with volume expansion and vasopressors as needed.

Measurements and results

Mean values from daily measurements of intracranial pressure (ICP), CPP, and simultaneous arterial and venous blood gases were evaluated during 72 h of cerebral monitoring. CPP values were significantly higher in survivors compared to nonsurvivors (81 ± 8.6 versus 71 ± 34 mmHg, 87 ± 8.7 versus 68 ± 23 mmHg and 87 ± 18 versus 69 ± 20 mmHg on days 1,2 and 3, respectively; P = 0.02). In 139 measurements obtained jugular venous oxygen saturation (SjvO₂) values did not correlate with CPP (r = 0.02; P = 0.08, NS).

Conclusion

In the first 72 h, ICP was significantly higher and CPP significantly lower in nonsurvivors. Dynamic evaluation in the first 72 h of injury shows trends towards higher SjvO₂ in nonsurvivors (NS). When patients were initially resuscitated before cerebral monitoring we found no correlation between SjvO₂ and CPP.