Pulmonary shunt as a prognostic indicator in head injury.

Severe head injury may cause momentary respiratory arrest. Resultant hypoxia would increase cerebral edema and adversely affect the quality of survival. This study examines the effect of hypoxemia on outcome. Pulmonary shunt was calculated as a convenient measurement of respiratory insufficiency in 86 severely head-injured patients who underwent surgery. All samples were taken shortly after induction into anesthesia when controlled ventilation with high inspired-oxygen concentration had been established. In 39 patients who improved, mean pulmonary shunt was 8.9%. Twelve patients who survived with deficit showed a mean shunt of 13.6%, and in 35 patients who died, the mean initial shunt was 15.6%. No significant correlation was found between abnormal chest x-ray findings or the occurrence of hypertension and shunt percentage. The American Society of Anesthesiologists at-risk classification correlated grossly with the outcome. Early pulmonary shunt is a prognostic indicator in severe head injury and should be used in conjunction with the Glasgow Coma Scale in assessing outcome. Despite an apparently adequate respiratory pattern, all patients with severe head injury must be assumed to be hypoxic until proven otherwise. While hypoxemia may prove to be refractory in overwhelming injury, patients who score low on the Glasgow Coma Scale but who have relatively normal oxygen exchange may still survive with little deficit.