Intraoperative jugular desaturation during surgery for traumatic intracranial hematomas

Traumatic intracranial hematomas which are present on hospital admission or which develop during the hospital course are associated with a worse neurological outcome than diffuse injuries. The purpose of this study was to monitor jugular venous oxygen saturation (SjvO₂) during surgery for evacuation of traumatic intracranial mass lesions, to determine the incidence and the causes of jugular venous desaturation, and to assess the usefulness of SjvO₂ monitoring in this setting. Twenty-five severely head injured patients were monitored during 27 surgical procedures. At the start of the surgical procedure, the median SjvO₂ was 47% (range 25%-89%). Seventeen (63%) of the patients had a SjvO₂ less than 50%. Five patients had extremely low SjvO₂ values (≤30%). Upon evacuation of the intracranial hematoma, there was a significant (P < 0.001) increase in the median SjvO₂ to 65% (range 50%-88%). Intracranial hypertension was the primary cause of the low SjvO₂, as confirmed by the response to surgical evacuation. Hypotension (mean arterial pressure <80 mm Hg) was a contributing factor in seven of the cases of jugular desaturation. The definitive treatment of a traumatic intracranial hematoma is surgical evacuation. However, during the period prior to evacuation of the hematoma, jugular venous desaturation was common, suggesting that monitoring SjvO₂ might provide useful information about the adequacy of cerebral perfusion.