MonitorizaciÓn de la saturaciÓn yugular de oxígeno y la isquemia cerebral en el paciente neurocrítico

Introduction. Catheterization of the jugular bulb is of great value in the study of cerebral metabolism, since it permits diagnosis of episodes of hypoxia and cerebral ischaemia. Objectives. To determine the frequency of the appearance of episodes ofdesaturation and cerebral ischaemia, whether these were simultaneous and their relation to the mortality in an intensive care unit (ICU), Patients and methods. We studied 21 neurocritical patients, recording the following data: age, sex, diagnosis and state at the time of discharge from the ICU (alive or dead). In the group of patients in whom the jugular bulb had been catheterised we also recorded: the side cannulated, complications, SyO 2 , cerebral lactate-oxygen index and modified cerebral lactate-oxygen. Results. In 57% of the patients we catheterised the jugular bulb and in 50% of them at least one episode of desaturation was recorded, and cerebral ischaemia in 42%. Only one patient had simultaneous desaturation and cerebral ischaemia. Of the six patients in whom desaturation was detected, 5 died in the ICU (83.3%). The mortality of patients with ischaemia was only 40%. 40% of the patients with head injuries were monitored and 50% of the non-monitoredpatients had head injuries. Conclusions. Episodes of desaturation are frequent in neurocritical patients and are associated with increased mortality. Recordings of lactate are not useful at present in the diagnosis of cerebral ischaemia.