[Arterio-jugular difference of oxygen and intracranial pressure in comatose, head injured patients. I. Technical aspects and complications]

The monitoring of the comatose head injured patients is based on the recording of several data; the intracranial pressure measurements (ICP), associated with the arterial pressure recording, gives a good estimate of the cerebral perfusion pressure (CPP) but further information about the cerebral perfusion are needed. Based on the assumption that the cerebral metabolic rate is kept constant strong relationships exist between the cerebral blood flow (CBF) and the arterovenous difference of oxygen (AVDO2). In order to obtain samples of cerebral venous blood a catheter must be inserted in the internal jugular vein (IJ) with the tip of the cannula reaching the superior jugular bulb. In 224 patients we measured the ICP trough ventricular or subdural catheters; invasive measurement of the arterial pressure was also carried on in all the patients. In 45 patients we measured the AVDO2 and we tested the safety and the reliability of the jugular vein cannulation. During the insertion of the jugular catheters a slight increase of ICP, without any clinical significance, was recorded; in two cases (on a total of 45) accidental carotid puncture occurred. In 9 cases we tested the concordance of the oxygen content between the two IJs; looking at the mean values no statistical difference is detected between the two sides but in some cases relevant differences are recorded. In two cases we inserted the catheters more cranially, reaching a sinus of the cranial basis; the blood collected from these points carries less oxygen that the blood collected in the neck. The rate of infection in this series of ICP monitoring is very low (1.78%) and we had no bleeding at the moment of the insertion of the catheters. Since no significant complications related to the IJ cannulation were recorded we conclude that these techniques are safe and can be easily performed in the clinical setting. Further studies are required in order to investigate the clinical meaning of the differences in the IJs content of oxygen.