Abstract
Purpose
To describe the technique of continuous jugular venous oxygen saturation (SjVO2) monitoring and review its applications in the neurointensive care unit (NICU), with special reference to the management of raised intracranial pressure (ICP) following severe acute brain injury.
Source
This narrative review is based on a selection of current literature on SjVO2 monitoring in conjunction with local experience using this technique.
Principal findings
Despite limitations, the use of SjVO2 monitoring has the potential to impact on patient care in the NICU. The placement of the catheter is relatively simple. Studies have confirmed that abnormalities in cerebral venous oxygen saturation are associated with adverse outcome following traumatic brain injury. There is evidence that SjVO2 may be a useful adjunct to ICP monitoring of patients with intracranial hypertension. Furthermore, managing cerebral extraction of oxygen in conjunction with cerebral perfusion pressure may result in an improved outcome. Further research in this area is needed. Other indications for SjVO2 monitoring include subarachnoid hemorrhage, cardiopulmonary bypass and following ischemic stroke.
Conclusion
In the past, the management of severe acute brain injury was targeted at ICP and perfusion pressure with little consideration for the metabolic requirements of the injured brain. SjVO2 monitoring is another tool the intensivist can use to obtain information about the global oxygen requirements of the injured brain on a continuous basis. Whether this will impact on care in the long term remains to be seen.
Résumé
Objectif
Décrire le monitorage continu de la saturation en oxygène de la veine jugulaire (SO2Vj) et revoir son application à l’unité des soins intensifs neurologiques (USIN) en évoquant spécialement le traitement de l’hypertension intracrânienne (HTIC) faisant suite à une sévère lésion cérébrale aiguë.
Source
La revue narrative repose sur une sélection d’articles récents sur le monitorage de la SO2Vj en conjonction avec une expérience locale d’utilisation de cette technique.
Constatations principales
Malgré certaines limites, l’utilisation du monitorage de la SO2Vj peut influencer les soins données à l’USIN. La mise en place du cathéter est relativement simple. Des études confirment que des anomalies de la saturation en oxygène du sang veineux cérébral sont associées à des complications suivant une lésion cérébrale traumatique. Il y a des indications à l’usage de la SO2Vj comme auxiliaire utile au monitorage de la PIC des patients souffrant d’hypertension intracrânienne. De plus, le contrôle de l’extraction cérébrale d’oxygène en conjonction avec celui de la pression de perfusion cérébrale pourrait améliorer l’évolution. Il faut toutefois poursuivre les recherches dans le domaine. D’autres indications pour le monitorage de la SO2Vj comprennent l’hémorragie sous-arachnoïdienne, la circulation extracorporelle et les suites d’un accident ischémique cérébral.
Conclusion
Dans le passé, le traitement d’une sévère lésion cérébrale aiguë ciblait la PIC et la pression de perfusion et attachait peu d’importance aux besoins métaboliques du cerveau lésé. Le monitorage de la SO2Vj est un autre outil que les intensivistes peuvent utiliser pour obtenir, en continu, de l’information sur les besoins globaux en oxygène du cerveau lésé. Il reste à déterminer si la technique influencera les soins à long terme.
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White, H., Baker, A. Continuous jugular venous oximetry in the neurointensive care unit — a brief review. Can J Anesth 49, 623–629 (2002). https://doi.org/10.1007/BF03017393
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DOI: https://doi.org/10.1007/BF03017393