Assessment of jugular blood oxygen and lactate indices for detection of cerebral ischemia and prognosis

Assessment of jugular blood oxygen and lactate indices for detection of cerebral ischemia and prognosis

Levels of jugular blood oxygen saturation (SjvO2) and lactate have been proposed as indicators of cerebral ischemia and prognosis. However, sensitivity and specificity of these markers remain unknown. We retrospectively analyzed records of a series of 43 comatose patients at risk for cerebral ischem...

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Published in:Journal of neurosurgical anesthesiology Vol. 16; no. 3; pp. 226 - 231
Main Authors: Artru, François, Dailler, Frédéric, Burel, Edith, Bodonian, Carole, Grousson, Sébastien, Convert, Jacqueline, Renaud, Bernard, Perret-Liaudet, Armand
Format: Journal Article
Language:English
Published: United States 01-07-2004
Subjects:
Brain Injuries - blood
Brain Injuries - diagnostic imaging
Brain Ischemia - blood
Brain Ischemia - diagnosis
Brain Ischemia - diagnostic imaging
Coma - blood
Glasgow Coma Scale
Humans
Intracranial Aneurysm - blood
Intracranial Aneurysm - diagnostic imaging
Jugular Veins - metabolism
Jugular Veins - physiology
Lactic Acid - blood
Monitoring, Intraoperative
Neurosurgical Procedures
Oxygen - blood
Prognosis
Retrospective Studies
ROC Curve
Tomography, X-Ray Computed
Treatment Outcome
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Summary:Levels of jugular blood oxygen saturation (SjvO2) and lactate have been proposed as indicators of cerebral ischemia and prognosis. However, sensitivity and specificity of these markers remain unknown. We retrospectively analyzed records of a series of 43 comatose patients at risk for cerebral ischemia, mainly after head injuries or subarachnoidal hemorrhage. Their SjvO2, jugulo-arterial lactate difference (VADLactate), and lactate-oxygen index (LOI) were determined every 8 hours. An increase in VADLactate and LOI was found, indicative of ischemia on CT scan, with threshold values of 0.30 mmol/L and 0.15, respectively. Sensitivity and specificity were 100% and 64%, respectively, for the VADLactate threshold, and 90% and 55%, respectively, for the LOI threshold. Regarding prediction of a poor outcome, only an increase in VADLactate had a predictive value with a sensitivity of 100% and specificity of 67%. No threshold value with sufficient sensitivity and specificity was found for SjvO2, as indicator of either ischemia or outcome. During progression to brain death, VADLactate and LOI reached abnormal levels earlier than cerebral perfusion pressure or SjvO2. They reacted markedly to focal ischemia due to vasospasm. Hyperlactacidemia rendered VADLactate and LOI uninterpretable by causing a brain lactate influx. Present data, if confirmed by a prospective study, would justify inclusion of intermittent VADLactate and LOI determinations in the multimodal cerebral monitoring.
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ISSN:0898-4921
DOI:10.1097/00008506-200407000-00007