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Introduction <p>Monitoring cerebral perfusion and metabolism is critical for mitigating secondary injury in Traumatic Brain Injury (TBI). The jugular bulb-to-arterial CO₂ difference (CO₂ gap) offers insights into regional cerebral perfusion and oxygen utilization, potentially serving as a prognostic biomarker in TBI. This study evaluates the prognostic significance of the CO₂ gap in predicting mortality in severe TBI.</p> Methods <p>Adult severe TBI patients post decompressive surgery requiring post-surgical ICU care were included. Jugular bulb and arterial blood gases were analyzed at 12, 24, and 48&#xa0;h post-surgery to calculate the CO₂ gap. Primary outcomes included temporal trends in CO₂ gap values, and secondary outcomes included mortality at 14 and 28 days. Statistical analysis utilized a linear mixed-effects model and survival analysis.</p> Results <p>Eleven patients were included, with 18.2% surviving to day 14 and 9.1% surviving to day 28. Non-survivors demonstrated a lower CO₂ gap initially, followed by raising CO₂ gap. Survivors had a higher CO₂ gap initially, followed by decreasing but maintained CO₂ gap.</p> Conclusion <p>In this small, high-acuity cohort of severe traumatic brain injury patients requiring decompressive surgery, temporal trends in the jugular bulb-to-arterial CO₂ difference differed between survivors and non-survivors. The CO₂ gap demonstrates potential as a dynamic marker of early prognosis in severe TBI. These findings are preliminary and hypothesis-generating and require validation in larger, representative cohorts before prognostic application.</p>

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Temporal trends in jugular bulb-to-arterial CO₂ difference as a prognostic biomarker in severe traumatic brain injury

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月2日

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  • Shweta Naik,
  • Rajesh Panda,
  • Sudhir V,
  • Mathangi Krishnakumar

摘要

Introduction

Monitoring cerebral perfusion and metabolism is critical for mitigating secondary injury in Traumatic Brain Injury (TBI). The jugular bulb-to-arterial CO₂ difference (CO₂ gap) offers insights into regional cerebral perfusion and oxygen utilization, potentially serving as a prognostic biomarker in TBI. This study evaluates the prognostic significance of the CO₂ gap in predicting mortality in severe TBI.

Methods

Adult severe TBI patients post decompressive surgery requiring post-surgical ICU care were included. Jugular bulb and arterial blood gases were analyzed at 12, 24, and 48 h post-surgery to calculate the CO₂ gap. Primary outcomes included temporal trends in CO₂ gap values, and secondary outcomes included mortality at 14 and 28 days. Statistical analysis utilized a linear mixed-effects model and survival analysis.

Results

Eleven patients were included, with 18.2% surviving to day 14 and 9.1% surviving to day 28. Non-survivors demonstrated a lower CO₂ gap initially, followed by raising CO₂ gap. Survivors had a higher CO₂ gap initially, followed by decreasing but maintained CO₂ gap.

Conclusion

In this small, high-acuity cohort of severe traumatic brain injury patients requiring decompressive surgery, temporal trends in the jugular bulb-to-arterial CO₂ difference differed between survivors and non-survivors. The CO₂ gap demonstrates potential as a dynamic marker of early prognosis in severe TBI. These findings are preliminary and hypothesis-generating and require validation in larger, representative cohorts before prognostic application.