Jugular Venous Saturation Research Articles

The Carbon Dioxide Responsiveness of Cerebral Oxygen Saturation

S354 INTRODUCTION: Continuous measurements of cerebral oxygen saturation (rSO2) and the change in hemoglobin density (HbI) measured by near infrared spectroscopy (NIRS) provide the information of the balance of supply and consumption of oxygen and cerebral blood volume noninvasively. To evaluate the measurement of rSO2 and HbI using NIRS technique for assessing the cerebrovascular carbon dioxide responsiveness, we compared with its responsiveness of both jugular venous saturation (SjO2) and the middle cerebral blood flow velocity (Vm) to varying PaCO2. METHODS: After CHR approval and written informed consent, 10 laminectomy patients were studied. Anesthetic induction and tracheal intubation was done with thiopental sodium 4-5 mg[center dot]kg-1 i.v. and vecuronium 0.8-0.1 mg[center dot]kg-1 i.v. Anesthesia was maintained with 0.5-1 % enflurane / 50% N2 O in O2. Radial artery was cannulated. The right side jugular bulb catheterization was done for the measurement of SjO2. The NIRS sensor (TOSTEC, Japan) was positioned on the right side of forehead to measure rSO2 and HbI. To measure Vm, transcranial Doppler probe was placed at the right temporal window. Simultaneous measurements of rSO2, HbI, SjO2 and Vm were performed at normo-, hypo- and hypercapnia. Descriptive data of rSO2, HbI, SjO2 and Vm were calculated at normo-, hypo- and hypercapnia and ANOVA was used for analysis. To compare the carbon dioxide responsiveness, linear regression analyses of rSO2, HbI, SjO2 and Vm, respectively, and PaCO2 were used. P < 0.05 was considered statistically significant RESULTS: (Table 1 and Table 2)Table 1: Descriptive DataTable 2: Results Using Linear Regression Analysis with PaCO2CONCLUSIONS: We conclude that lesser degree of carbon dioxide responsiveness of rSO2 and HbI was observed comparing its responsiveness of SjO2 and Vm. But, NIRS can be a useful noninvasive technique for assessing the cerebrovasular carbon dioxide responsiveness.

Accuracy of a cerebral oximeter in healthy volunteers under conditions of isocapnic hypoxia.

A cerebral oximeter measures oxygen saturation of brain tissue noninvasively by near infrared spectroscopy. The accuracy of a commercially available oximeter was tested in healthy volunteers by precisely controlling end-tidal oxygen (P[ET]O2) and carbon dioxide (P[ET]CO2) tensions to alter global cerebral oxygen saturation. In 30 healthy volunteers, dynamic end-tidal forcing was used to produce step changes in P[ET]O2 resulting in arterial saturation ranging from approximately 70% to 100% under conditions of controlled normocapnia (each person's resting P[ET]CO2) or hypercapnia (resting plus 7-10 mmHg). Blood arterial (SaO2) and jugular bulb venous (S[jv]O2) saturations during each P(ET)O2 interval were determined by co-oximetry. The cerebral oximeter reading (rSO2) and an estimated jugular venous saturation (S[jv]O2), derived from a combination of SaO2 and rSO2, were compared with the measured S(jv)O2. The S(jv)O2 was significantly higher with hypercapnia than with normocapnia for the same SaO2. The rSO2 and S(jv)O2 were both highly correlated with S(jv)O2 for individual volunteers (mean r2 = 0.91 for each relation); however, the slopes and intercepts varied widely among volunteers. In three of them, the cerebral oximeter substantially underestimated the measured S(jv)O2. During isocapnic hypoxia in healthy persons, cerebral oxygenation as estimated by near infrared spectroscopy precisely tracks changes in measured S(jv)O2 within individuals, but the relation exhibits a wide range of slopes and intercepts. Therefore the clinical utility of the device is limited to situations in which tracking trends in cerebral oxygenation would be acceptable.

Evaluation of near infrared spectroscopy in patients with traumatic brain injury.

Near infrared spectroscopy provides a continuous noninvasive measure of changes in regional cerebral oxygen (rSO2) and quantifies these changes into a single index (Somanetics, Corporation). McCormick et al1 originally validated this index from gas analysis studies of normal adults where they found that the rSO2 index represented a summation of differential weighting of arterial O2 saturation (SaO2) (20%), jugular venous O2 saturation (SvjO2) (75%), and extracranial O2 saturation (5%).KeywordsTraumatic Brain InjuryCerebral Perfusion PressureCerebral OxygenNear Infrared SpectroscopyCerebral OximetryThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Potential problems with simplified selective cerebral perfusion--experimental investigations and clinical improvements.

Currently the most used perfusion techniques during aortic arch surgery to prevent cerebral damage include hypothermic circulatory arrest, retrograde cerebral perfusion and selective cerebral perfusion (SCP). The application of simplified SCP, which does not require deep hypothermia, has become an alternative procedure for brain protection. Including the physiological principle of autoregulated cerebral blood flow, cerebral perfusion flow is not predetermined, but differentiated from the different cannula sizes for the lower and upper body perfusion. In a mock circulation loop, we could show that resistance changes in the two compartments led to flow shifts between the systemic and brachiocephalic regions. In addition to mechanical factors cerebral perfusion is determined from physiological changes. In practice, these shifts can be initiated with disrupted autoregulation due to ph-stat management or dramatic pressure changes. To prevent mismatched cerebral perfusion extended perioperative monitoring was included in our clinical setting. With bilateral somatosensory evoked potentials, a computer aided topographical electroencephalometry system, transcranial doppler-sonography and jugular venous bulb saturation, we could provide a sufficient bihemispheric perfusion. Between 1990 and 1995 we operated on 21 patients using SCP. Intraoperatively no signs of cerebral ischaemia due to inadequate perfusion could be observed. Only temporary neurological changes were found postoperatively. In summary, the simplified SCP, despite its physiological basis, is intricately involved in control and influence. We think that the application of SCP is safe if extended neurophysiological monitoring is included in the clinical setting.

Patient management in head injury care: a nursing perspective.

Through a review of the literature, this article provides a consideration of nursing responsibilities and nursing care in the management of patients with head injuries. A brief review of the pathophysiology of head injury is followed by a description of intracranial pressure (ICP) monitoring and cerebral perfusion pressure (CPP) measurement, using the Camino fibreoptic catheter and monitor, with exploration of pulse and trend waveforms and their significance in assessing cerebral compliance. Jugular venous bulb saturation (SjO2) monitoring adds another dimension to the assessment of neurological damage by demonstrating cerebral tissue perfusion and cerebral metabolic rate, and this is also discussed. After identification of assessment as a crucial part of the nursing role, aspects of nursing care of head-injured patients are discussed. The discussion of respiratory support measures includes the controversial use of hyperventilation in reducing ICP, the prevention of hypoxia, the risk of respiratory complications, the use of suctioning and turning to prevent these and the problems associated with these nursing care measures. Other aspects of care are also considered, including careful positioning and temperature control, and the benefits of mild hypothermia.

Society of Neurosurgical Anesthesia and Critical Care

Society of Neurosurgical Anesthesia and Critical Care

The use of cephalad cannulae to monitor jugular venous oxygen content during extracorporeal membrane oxygenation.

BACKGROUND: When used during extracorporeal membrane oxygenation (ECMO), jugular venous bulb catheters, known as cephalad cannulae, increase venous drainage, augment circuit flow and decompress cerebral venous pressure. Optimized cerebral oxygen delivery during ECMO may contribute to a reduction in neurological morbidity. This study describes the use of cephalad cannulae and identifies rudimentary data for jugular venous oxygen saturation (JVO2) and arterial to jugular venous oxygen saturation difference (AVDO2) in this patient population. RESULTS: Patients on venoarterial (VA) ECMO displayed higher JVO2 (P < 0.01) and lower AVDO2 (P = 0.01) than patients on venovenous (VV) ECMO (P < 0.01). During VV ECMO, JVO2 was higher and AVDO2 lower when systemic pH was < 7.35 rather than > 7.4 (P = 0.01). During VA ECMO, similar differences in AVDO2 but not in JVO2 were observed at different pH levels (P = 0.01). CONCLUSIONS: Jugular venous saturation and AVDO2 were influenced by systemic pH, ECMO type and patient age. These data provide the foundation for normative values of JVO2 and AVDO2 in neonates and children treated with ECMO.

Plasma antioxidant consumption associated with ischemia/reperfusion during carotid endarterectomy.

Thirteen patients undergoing carotid endarterectomy were studied to correlate changes in jugular bulb venous oxygen saturation (SjO2) with indices of free radical production during cerebral ischemia/reperfusion. Levels of oxidant species were also monitored in arterial samples to determine any change across the cerebral circulation. Blood was sampled from a venous catheter inserted in the ipsilateral jugular bulb and from an arterial catheter. Co-oximetry measurements were made to determine jugular bulb venous oxygenation saturation. To monitor changes in oxidant stress, a colorimetric assay was used to determine plasma antioxidant potential, and electron paramagnetic resonance spectroscopy was used to quantify free radical-spin trap adducts formed in a blood sample treated with the spin trap alpha-tert-butyl phenyl nitrone (PBN). SjO2 decreased significantly from 68 +/- 11% to 61 +/- 10% (P < .05) during clamping of the internal carotid artery and returned to baseline (65 +/- 11%) when the carotid clamp was removed. Jugular venous plasma antioxidant potential decreased significantly from 32.76 +/- 5.42% inhibition to 28.02 +/- 6.77% inhibition (P < .05). There was no concomitant change in arterial plasma antioxidant potential values, indicating a decrease in antioxidant capacity across the cerebral circulation. However, analysis of spin trap-free radical adducts did not provide conclusive evidence for free radical production. These results provide supportive evidence for oxidant production during cerebral ischemia/reperfusion in a clinical setting.

Jugular Venous Bulb Oxyhemoglobin Saturation During Cardiac Surgery

Jugular Venous Bulb Oxyhemoglobin Saturation During Cardiac Surgery

Monitoring cerebral perfusion by combined transcranial Doppler (TCD) and jugular venous blood saturation (S jO 2) in anesthesiology

Monitoring cerebral perfusion by combined transcranial Doppler (TCD) and jugular venous blood saturation (S jO 2) in anesthesiology

Cerebral oxygenation measured by near-infrared spectroscopy: Comparison with jugular bulb oximetry

Near-infrared spectroscopy is a potential tool for measuring adequacy of cerebral oxygenation during cardiac operations. The cerebral microcirculation is predominantly venous (by volume) and therefore regional cerebral oxygenation measured by near-infrared spectroscopy should reflect jugular bulb venous saturations. We compared simultaneous regional cerebral oxygenation and jugular bulb venous saturation measurements in 40 children (median age, 4.5 years; range 2 weeks to 14.5 years) in the cardiac catheter laboratory (n = 29) and during cardiac operations (n = 11). For all patients combined the correlation between regional cerebral oxygenation and jugular bulb venous saturation was 0.69 (p < 0.0001) and was similar for the two groups. For individual children undergoing cardiac operations excellent correlations were obtained (r = 0.78 to 0.96; median, 0.91). However, at low values of jugular bulb venous saturation, regional cerebral oxygenation tended to run high, whereas the converse was true for high values of jugular bulb venous saturation. These findings suggest that near-infrared spectroscopy may be a useful tool for assessing intravascular cerebral oxygenation during pediatric cardiac operations. Prospective studies of neurologic outcome will be required to establish the value of this technique for assessing the adequacy of cerebral protection.

Validation in Volunteers of a Near-Infrared Spectroscope for Monitoring Brain Oxygenation In Vivo

Cerebral oximeters based on near-infrared spectroscopy may provide a continuous, noninvasive assessment of cerebral oxygenation. We evaluated a prototype cerebral oximeter (Invos 3100; Somanetics, Troy, MI) in 22 conscious, healthy volunteers breathing hypoxic gas mixtures. Using the first 12 subjects (training group), we developed an algorithm based on the mathematic relationship that converts detected light from the field surveyed by the probe to cerebral hemoglobin oxygen saturation (CSfO2). To develop the algorithm, we correlated the oximeter result with the estimated combined brain hemoglobin oxygen saturation (CScombO2, where CScombO2 = SaO2 x 0.25 + SjO2 x 0.75 and SjO2 = jugular venous saturation). We then validated the algorithm in the remaining 10 volunteers (validation group). A close association (r2 = 0.798-0.987 for individuals in the training group and r2 = 0.794-0.992 for individuals in the validation group) existed between CSfO2 and CScombO2. We conclude that continuous monitoring with cerebral oximetry may accurately recognize decreasing cerebral hemoglobin oxygen saturation produced by systemic hypoxemia.

Near-infrared spectroscopy use in patients with head injury.

A multimodality recording system was used in 14 ventilated patients with closed head injury to assess the potential use of near-infrared spectroscopy (NIRS) in the neurointensive care unit. Signals of intracranial pressure, cerebral perfusion pressure, peripheral oxygen saturation, jugular venous saturation, and NIRS-derived changes in the chromophores of oxy- and deoxyhemoglobin were digitized and recorded. After a review of 886 hours of continuous monitoring, 376 hours were considered free from artifact and were entered for final analysis. In nine of the patients 38 events were recorded that demonstrated clear changes in cerebral perfusion pressure accompanied by hemodynamic changes in middle cerebral artery flow velocity (transcranial Doppler) and cortical perfusion (laser Doppler flowmetry). Near-infrared spectroscopy showed correlated changes in 37 events (97%) whereas jugular venous saturation monitoring registered only 20 (53%). There was associated peripheral oxygen desaturation in eight cases (21%), intracranial hypertension in 10 (26%), and cerebral hyperemia in eight (21%). The remaining 12 events (32%) appeared to be complex changes of uncertain origin. Iatrogenic factors were identified as causative in 14 cases (37%). The potential application of NIRS in adults and the importance of using multiple parameter recording systems in the interpretation of cerebral events are discussed.

Effect of hyperventilation, mannitol, and ventriculostomy drainage on cerebral blood flow after head injury.

Therapies to lower intracranial pressure (ICP) after traumatic brain injury (TBI) include hyperventilation (HV), intravenous mannitol (IM), and cerebrospinal fluid drainage from a ventriculostomy (DV). To determine the effects of these therapies on cerebral blood flow (CBF), fiberoptic oximetry was used to measure jugular venous O2 saturation (SjvO2) as an index of the CBF to cerebral metabolic rate for O2 (CMRO2) ratio after IM (25 g IV for more than 5 min), DV (3 min), or HV (increase respiratory rate by 4) therapy for elevated ICP. Assuming CMRO2 is constant, changes in SjvO2 reflect changes in CBF. Continuous measurements of SjvO2, ICP, blood pressure, arterial O2 saturation, and end-tidal CO2 were obtained in 22 patients with a Glasgow Coma Scale score of 5.3 +/- 0.4 (mean +/- SD) in the first 5 days after TBI. Therapy was initiated a total of 196 times when ICP was > 15 mm Hg for > 5 minutes, and measurements made at 20 minutes after treatment were compared with those made just before. After DV, ICP fell in 90% of the observations by 8.6 +/- 0.7 mm Hg (mean +/- SEM, n = 119); after IM, ICP fell in 90% of the observations by 7.4 +/- 0.7 mm Hg (n = 43); and after HV, ICP fell in 88% of the observations by 6.3 +/- 1.2 mm Hg (n = 14). In patients where ICP fell, SjvO2 increased by 2.49 +/- 0.7% saturation (from 68.0 +/- 1.3%) with IM, but only by 0.39 +/- 0.4% saturation (from 67.2 +/- 0.9%) with DV.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparing two strategies of cardiopulmonary bypass cooling on jugular venous oxygen saturation in neonates and infants

Cerebral protection during deep hypothermic circulatory arrest is predicted on efficient and complete cerebral cooling. Institutions approach cooling quite differently. We compared two different cooling strategies in terms of measured jugular venous bulb saturations in 39 infants undergoing deep hypothermic cardiopulmonary bypass to evaluate the effect of institutional cooling practices on jugular venous bulb saturation, an indirect measure of cerebral cooling efficiency. The patients were grouped based on the method of core cooling. In group A (n = 17), core cooling was achieved rapidly by setting the water bath temperature of the heat exchanger at 4 degrees to 5 degrees C, and the patient was cooled until rectal temperature and nasopharyngeal temperature were 15 degrees C or lower. In group B (n = 22), the heat exchanger was initially set at 18 degrees C and slowly lowered to 12 degrees C. Hypothermic temperatures of 12 degrees C were maintained until the nasopharyngeal temperature was 18 degrees C or less and the rectal temperature was 20 degrees C or lower. Once cooling was complete, blood samples were analyzed by cooximetry for determination of arterial oxygen saturation and jugular venous bulb saturation. In group A, the measured jugular venous bulb saturation was 98.0% +/- 0.9% and the oxygen saturation to jugular venous bulb saturation difference was 0.3% +/- 0.5%, measured at the time that institutional cooling objectives were achieved (total cooling time, 15.0 +/- 0.45 minutes). In group B, jugular venous bulb saturation was 86.2% +/- 12% and the oxygen saturation to jugular venous bulb saturation difference was 10.8% +/- 12.2%, measured at the time that institutional cooling objectives were achieved (total cooling time, 17.5 +/- 1.1 minutes (p < 0.01). Differences in cardiopulmonary bypass cooling techniques may alter the rate at which jugular bulb saturations rise. We believe this represents an indirect measure of the efficiency of brain cooling and therefore of cerebral protection.

The Speed of Blood Withdrawal Affects The Accuracy of Jugular Venous Bulb Orygen Saturation Measurements

The Speed of Blood Withdrawal Affects The Accuracy of Jugular Venous Bulb Orygen Saturation Measurements

Jugular bulb saturation and mixed venous saturation during cardiopulmonary bypass.

Systemic venous oxygen saturation is clinically used as an indicator of a satisfactory oxygen supply demand balance on cardiopulmonary bypass (CBP). Cerebral desaturation has been associated with postoperative cognitive dysfunction and has an incidence of 17% to 23% on bypass. We tested the hypothesis that systemic venous saturation did not correlate with jugular bulb venous saturation. Blood was drawn from the radial artery, jugular bulb catheter, and venous return line for determination of pH, oxygen tension and saturation, and carbon dioxide tension at four times during bypass: warm 1 (following initiation of CPB); cold 1 (stable hypothermia); cold 2 (hypothermia prior to rewarm); and warm 2 (nasopharyngeal temperature 36 degrees C to 37 degrees C). Correlations of jugular bulb and systemic venous saturation at cold 1 were r = 0.29, r2 = 0.08, and p = 0.0005, and at warm 2 were r = 0.22, r2 = 0.05, and p = 0.007. We conclude that systemic saturation is a poor indicator of cerebral saturation. The poor association of jugular and systemic pump venous saturations underscores our inability to evaluate adequacy of cerebral perfusion. Jugular saturation is lower than pump venous return blood, especially at times of lower oxygen delivery, thus either continuous invasive or noninvasive evaluation of cerebral oxygenation is required to evaluate the adequacy of cerebral perfusion.

Measurement of Jugular Venous Bulb Oxyhemoglobin Saturation and Cerebral Dysfunction in Patients Undergoing Cardiopulmonary Bypass at Moderate or Mild Hypothermia

Measurement of Jugular Venous Bulb Oxyhemoglobin Saturation and Cerebral Dysfunction in Patients Undergoing Cardiopulmonary Bypass at Moderate or Mild Hypothermia

The Role of Jugular Venous Oxyhemoglobin Saturation Monitoring During Cardic Surgery

Postoperative brain damage is one of most serious complications of cardiopulmonary bypass (CPB). To prevent brain damage during CPB, adequate cerebral perfusion for cerebral oxygen demand should be maintained. This study monitored jugular venous oxyhemoglobin saturation (), which reflects the overall balance of cerebral oxygen supply and demand, intermittently in 10 patients undergoing cardiac surgery. At the initiation of CPB, in spite of a significant decrease in mean arterial pressure, did not change, and it was stable during the hypothermic period of CPB. But a significan reduction in was observed during the rewarming period, and had an inverse linear correlation with esophageal temperature. Furthermore, the percent decrease of was related to rewarming speed. Therefore, therapeutic approaches for desaturation include slower rewarming, increasing cerebral blood flow, decreasing the cerebral metabolic rate for oxygen, increasing oxygen content, and increasing perfusion flow rate.

A comparison of two systems for assessing cerebral venous oxyhaemoglobin saturation during cardiopulmonary bypass in humans

The Somanetics Invos 3,100 cerebral oximeter is a new noninvasive device which measures the regional oxygen saturation of haemoglobin within the cerebral microvasculature by infrared spectroscopy. It was used in nine patients undergoing elective cardiac surgery and its results were compared with measurements of jugular venous bulb saturations obtained by the Oximetrix Opticath oximetry system. The index value of jugular venous bulb saturation was obtained by analysis of jugular bulb blood in an Il282 cooximeter. The cerebral oximeter was less accurate and precise (standard deviation of difference 14.1%) than the Oximetrix system (standard deviation of the difference 2.65%) and also demonstrated a systematic error in bias unrelated to cerebral perfusion pressure. The cerebral oximeter may therefore be less useful than jugular venous bulb saturation in the clinical management of patients undergoing cardiopulmonary bypass.