ObjectiveTo evaluate outcome from severe acute traumatic diffuse brain swelling, in relation to early patterns of global cerebral extraction of oxygen.DesignProspective, interventional study.SettingNeuroscience intensive care unit of a university hospital.PatientsAdults (n equals 205) with acute, essentially isolated brain trauma (predominantly diffuse brain swelling), undergoing routine early monitoring of cerebral extraction of oxygen and intracranial pressure, along with other monitoring modalities.InterventionsRoutine neuroemergency procedures.Measurements and Main ResultsCerebral extraction of oxygen (arteriojugular oxyhemoglobin saturation difference) was measured in each patient, early in the acute phase (2 to 8 hrs postinjury). Outcome at 6 months postinjury was significantly better in patients with initially increased cerebral extraction of oxygen (more than 42%) than in those patients with normal (24% to 42%) or decreased (less than 24%) values. In contrast, no significant differences were found among these three groups with respect to age, initial Glasgow Coma Scale score, intracranial pressure, cerebral perfusion pressure, Paco2, total hemoglobin content, and time from injury when the initial measurements were performed.ConclusionsInitially increased cerebral extraction of oxygen appears to indicate global cerebral viability rather than cerebral ischemia in patients with acute traumatic diffuse brain swelling.(Crit Care Med 1996; 24:953-956)