Summary
Jugular bulb oximetry provides the first bedside, continuously available information on cerebral perfusion adequacy. An extensive analysis was made of all jugular bulb oxygen saturation (SjO2) data obtained in 50 patients suffering from severe head injury. A total of 176 periods (more than 30 minutes) with reliable, abnormal SjO2-values was observed, with 62 desaturation periods (SjO2 < 55%) and 114 high SjO2-periods (SjO2 > 80%). Jugular desaturation periods were predominantly observed in the first 2 days of monitoring and seemed the most closely correlated to lowered cerebral perfusion pressure and lowered arterial carbon dioxide tension. The high SjO2-values were more equally distributed over the first 5 days of monitoring and seemed mostly correlated to increased arterial carbon dioxide tension. Highlights of the general management of severely head injured patients is discussed, focussing attention on the importance of cerebral perfusion pressure and normoventilation.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Bouma GJ, Muizelaar JP, Stringer WAet al (1992) Ultra-early evaluation of regional cerebral blood flow in severely head injured patients with xenon-enhanced computerized tomography. J Neurosurg 77: 360–368
Chan KH, Dearden MM, Miller JDet al (1992) The effect of changes in cerebral perfusion pressure upon middle cerebral artery blood flow velocity and jugular bulb oxygen saturation after severe head injury. J Neurosurg 77: 55–61
Chesnut RM, Marshall LF, Piek Jet al (1993) Early and late systemic hypotension as a frequent and fundamental source of cerebral ischemia following severe brain injury in the Traumatic Coma Data Bank. Acta Neurochir (Wien) [Suppl] 59: 121–125
Cold GE, Jensen FT, Malmros R (1977) The effects of PaCO2 reduction on regional cerebral blood flow in the acute phase of brain injury. Acta Anaesthesiol Scand 21: 359–367
Cruz J, Jaggi J, Hoffstad OJ (1993) Cerebral blood flow and oxygen consumption in acute brain injury with acute anemia: an alternative for the cerebral metabolic rate of oxygen consumption. Crit Care Med 21: 1218–1224
Dearden NM (1991) Jugular bulb venous oxygen saturations in the management of severe head injury. Current Opin Anesthesiol 4: 279–286
Dearden NM (1992) SjO2 and critical perfusion pressure after severe brain injury. Br J Int Care [Suppl 1]: 7–11
Moss E, Dearden NM, Berridge JC (1995) Effects of changes in mean arterial pressure on SJO2 during cerebral aneurysm surgery. Br J Anesth 75: 527–530
De Deyne C, Decruyenaere J, Colardyn F (1994) New insights in the management of acute neurologic crises using jugular bulb oximetry. In: Vincent JL (ed) Update in Int Care and Emerg Medicine. Springer, Berlin Heidelberg New York Tokyo, pp 638–645
De Deyne C, Decruyenaere J, Colardyn F (1996) How to interpret jugular bulb oximetry? In: Vincent JL (ed) Update in Int Care and Emerg Medicine, Springer, Berlin Heidelberg New York Tokyo, pp 731–741
Enevoldsen EM, Jensen FT (1978) Autoregulation and CO2-responses of cerebral blood flow in patients with acute severe head injury. J Neurosurg 48: 689–703
Gopinath SP, Robertson CS, Contant CFet al (1994) Jugular venous desaturation and outcome after head injury. J Neurol Neurosurg Psychiatry 57: 717–723
Hantson P, Mahieu P (1992) Usefulness of cerebral venous monitoring through jugular bulb catheterization for the diagnosis of brain death. Int Care Med 18 (1): 59 (Letter)
Jakobsen M, Enevoldsen E (1989) Retrograde catheterization of the right internal-jugular vein for serial measurements of cerebral venous oxygen content. J Cereb Blood Flow Metab 9: 717–720
Lewis SB, Myburgh JA, Reilly PL (1995) Detection of cerebral venous desaturation by continuous jugular bulb oximetry following acute neurotrauma. Anaesth Intens Care 23: 307–314
Marion DW, Darby JM, Yonas Het al (1991) Acute regional cerebral blood flow changes caused by severe head injury. J Neurosurg 74: 407–414
Miller JD (1985) Head injury and brain ischaemia: implications for therapy. Br J Anesthesiol 57: 102–129
Muizelaar JP, Marmarou A, Ward JDet al (1991) Adverse effects of prolonged hyperventilation in patients with severe head injury. A randomized trial. J Neurosurg 75: 731–739
Murr R, Schurer L (1995) Correlation of jugular venous oxygen saturation to spontaneous fluctuations of cerebral perfusion pressure in patients with severe head injury. Neurol Res 17: 329–333
Obrist WD, Langiftt TW, Jaggi JLet al (1984) Cerebral blood flow and metabolism in comatose patients with acute head injury. Relationship to intracranial hypertension. J Neurosurg 61: 241–253
Robertson CS, Grossman RG, Goodman JCet al (1987) The predictive value of cerebral anaerobic metabolism with cerebral infarction after head injury. J Neurosurg 67: 361–368
Robertson CS, Narayan RK, Gokoslanet al (1989) Cerebral arteriovenous oxygen difference as an estimate of cerebral blood flow in comatose patients. J Neurosurg 70: 222–230
Rosner MJ (1986) Cerebral perfusion pressure, intracranial pressure and head elevation. J Neurosurg 65: 636–641
Rosner MJ (1990) Cerebral perfusion pressure management in head injury. J Trauma 30: 933–940
Rosner MJ, Rosner SD, Johnson AH (1995) Cerebral perfusion pressure: management protocol and clinical results. J Neurosurg 83: 949–962
Sheinberg M, Kanter M, Robertson CSet al (1992) Continuous monitoring of jugular venous oxygen saturation in head-injured patients. J Neurosurg 76: 212–217
Schneider GH, v Helden A, Lanksch WR, Unterberg A (1995) Continuous monitoring of jugular bulb oxygen saturation in comatose patients — therapeutic implications. Acta Neurochir (Wien) 134: 71–75
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
de Deyne, C., Vandekerckhove, T., Decruyenaere, J. et al. Analysis of abnormal jugular bulb oxygen saturation data in patients with severe head injury. Acta neurochir 138, 1409–1415 (1996). https://doi.org/10.1007/BF01411119
Issue Date:
DOI: https://doi.org/10.1007/BF01411119