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My paper 20 years later: cerebral venous oxygen saturation studied with bilateral samples in the internal jugular veins

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Abstract

Introduction

Jugular oxygen saturation monitoring was introduced in neurointensive care after severe traumatic brain injury (TBI) to explore the adequacy of brain perfusion and guide therapeutic interventions. The brain was considered homogeneous, and oxygen saturation was taken as representative of the whole organ. We investigated whether venous outflow from the brain was homogeneous by measuring oxygen saturation simultaneously from the two jugular veins.

Methods

In 32 comatose TBI patients both internal jugular veins (IJs) were simultaneously explored using intermittent samples; hemoglobin saturation was also recorded continuously by fiber-optic catheters in five patients. In five cases long catheters were inserted bilaterally upstream, up to the sigmoid sinuses.

Main findings

On average, measurements from the two sides were in agreement (mean and standard deviation of the differences between the saturation of the two IJs were respectively 5.32 and 5.15). However, 15 patients showed differences of more than 15 % in hemoglobin saturation at some point; three others showed differences larger than 10 %. No relationship was found between the computed tomographic scan data and the hemoglobin saturation pattern.

Discussion/conclusion

Several groups have confirmed differences between oxygen saturation in the two jugular veins. After years of enthusiasm, interest for jugular saturation has decreased and more modern methods, such as tissue oxygenation monitoring, are now available. Jugular saturation monitoring has low sensitivity, with the risk of missing low saturation, but high specificity; moreover it is cheap, when used with intermittent sampling. Monitoring the adequacy of brain perfusion after severe TBI is essential. However the choice of a specific monitor depends on local resources and expertise.

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References

  1. Miller JD, Butterworth JF, Gudeman SK et al (1981) Further experience in the management of severe head injury. J Neurosurg 54:289–299. doi:10.3171/jns.1981.54.3.0289

    Article  CAS  PubMed  Google Scholar 

  2. Wärme PE, Bergström R, Persson L (1991) Neurosurgical intensive care improves outcome after severe head injury. Acta Neurochir (Wien) 110:57–64

    Article  Google Scholar 

  3. Becker DP, Miller JD, Ward JD et al (1977) The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg 47:491–502. doi:10.3171/jns.1977.47.4.0491

    Article  CAS  PubMed  Google Scholar 

  4. Marmarou A, Anderson R, Ward J et al (1991) Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J Neurosurg 75:s59–s66

  5. Changaris DG, McGraw CP, Richardson JD et al (1987) Correlation of cerebral perfusion pressure and Glasgow coma scale to outcome. J Trauma 27:1007–1013

    Article  CAS  PubMed  Google Scholar 

  6. Rosner MJ, Daughton S (1990) Cerebral perfusion pressure management in head injury. J Trauma 30:933–940

    Article  CAS  PubMed  Google Scholar 

  7. Bell BA (1984) A history of the study of the cerebral circulation and the measurement of cerebral blood flow. Neurosurgery 14:238–246

    Article  CAS  PubMed  Google Scholar 

  8. Shoemaker WC, Appel PL, Kram HB et al (1988) Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 94:1176–1186

    Article  CAS  PubMed  Google Scholar 

  9. Gibbs E, Lennox W, Nims L, Gibbs F (1942) Arterial and cerebral venous blood. Arterial–venous differences in man. J Biol Chem 144:325–332

    CAS  Google Scholar 

  10. Larson C, Ehrenfeld W, Wade J, Wylie E (1967) Jugular venous oxygen saturation as an index of adeguacy of cerebral oxygenation. Surgery 62:31–39

  11. Obrist WD, Langfitt TW, Jaggi JL et al (1984) Cerebral blood flow and metabolism in comatose patients with acute head injury. Relationship to intracranial hypertension. J Neurosurg 61:241–253. doi:10.3171/jns.1984.61.2.0241

    Article  CAS  PubMed  Google Scholar 

  12. Robertson CS, Narayan RK, Gokaslan ZL et al (1989) Cerebral arteriovenous oxygen difference as an estimate of cerebral blood flow in comatose patients. J Neurosurg 70:222–230. doi:10.3171/jns.1989.70.2.0222

    Article  CAS  PubMed  Google Scholar 

  13. Cruz J, Miner ME, Allen SJ et al (1990) Continuous monitoring of cerebral oxygenation in acute brain injury: injection of mannitol during hyperventilation. J Neurosurg 73:725–730. doi:10.3171/jns.1990.73.5.0725

    Article  CAS  PubMed  Google Scholar 

  14. Cruz J (1993) Combined continuous monitoring of systemic and cerebral oxygenation in acute brain injury: preliminary observations. Crit Care Med 21:1225–1232

    Article  CAS  PubMed  Google Scholar 

  15. Gopinath SP, Robertson CS, Contant CF et al (1994) Jugular venous desaturation and outcome after head injury. J Neurol Neurosurg Psychiatry 57:717–723

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. Dearden NM (1991) Jugular bulb venous oxygen saturation in the management of severe head injury. Curr Opin Anaesthesiol 4:279–286

    Article  Google Scholar 

  17. Stocchetti N, Paparella A, Bridelli F et al (1994) Cerebral venous oxygen saturation studied with bilateral samples in the internal jugular veins. Neurosurgery 34:38–43

    Article  CAS  PubMed  Google Scholar 

  18. Gibbs E, Lennox W, Gibbs F (1945) Bilateral internal jugular blood. Comparison of A-V differences, oxygen-dextrose ratios and respiratory quotients. Am J Psychiatry 102:184–190

    Article  CAS  Google Scholar 

  19. Metz C, Holzschuh M, Bein T et al (1998) Monitoring of cerebral oxygen metabolism in the jugular bulb: reliability of unilateral measurements in severe head injury. J Cereb Blood Flow Metab 18:332–343. doi:10.1097/00004647-199803000-00012

    Article  CAS  PubMed  Google Scholar 

  20. Triginer C, Robles A, Baguena M et al (1995) Differences in bilateral jugular bulb oxygen saturation values in severe head injured patients. Intensive Care Med 21:S51

    Google Scholar 

  21. Inagawa H, Okada Y, Suzuki S, Ono K (1995) Bilateral jugular bulb oximetry. In: Tsubokawa T, Marmarou A, Robertson C, Teasdale G (eds) Neurochemical monitoring in the intensive care unit. Springer, Tokyo, pp 112–119

  22. Latronico N, Beindorf AE, Rasulo FA et al (2000) Limits of intermittent jugular bulb oxygen saturation monitoring in the management of severe head trauma patients. Neurosurgery 46:1131–1138

    Article  CAS  PubMed  Google Scholar 

  23. Coles JP, Cunningham AS, Salvador R et al (2009) Early metabolic characteristics of lesion and nonlesion tissue after head injury. J Cereb Blood Flow Metab 29:965–975. doi:10.1038/jcbfm.2009.22

    Article  PubMed  Google Scholar 

  24. Marion DW, Darby J, Yonas H (1991) Acute regional cerebral blood flow changes caused by severe head injuries. J Neurosurg 74:407–414. doi:10.3171/jns.1991.74.3.0407

    Article  CAS  PubMed  Google Scholar 

  25. Beards SC, Yule S, Kassner A, Jackson A (1998) Anatomical variation of cerebral venous drainage: the theoretical effect on jugular bulb blood samples. Anaesthesia 53:627–633

    Article  CAS  PubMed  Google Scholar 

  26. Kelly DF, Kordestani RK, Martin NA et al (1996) Hyperemia following traumatic brain injury: relationship to intracranial hypertension and outcome. J Neurosurg 85:762–771. doi:10.3171/jns.1996.85.5.0762

    Article  CAS  PubMed  Google Scholar 

  27. Cruz J (1998) The first decade of continuous monitoring of jugular bulb oxyhemoglobinsaturation: management strategies and clinical outcome. Crit Care Med 26:344–351

    Article  CAS  PubMed  Google Scholar 

  28. Stocchetti N, Rossi S, Buzzi F et al (1999) Intracranial hypertension in head injury: management and results. Intensive Care Med 25:371–376

    Article  CAS  PubMed  Google Scholar 

  29. Le Roux PD, Newell DW, Lam AM et al (1997) Cerebral arteriovenous oxygen difference: a predictor of cerebral infarction and outcome in patients with severe head injury. J Neurosurg 87:1–8. doi:10.3171/jns.1997.87.1.0001

    Article  PubMed  Google Scholar 

  30. Cormio M, Robertson CS (2001) Ultrasound is a reliable method for determining jugular bulb dominance. J Neurosurg Anesthesiol 13:250–254

    Article  CAS  PubMed  Google Scholar 

  31. Coplin WM, O’Keefe GE, Grady MS et al (1997) Thrombotic, infectious, and procedural complications of the jugular bulb catheter in the intensive care unit. Neurosurgery 41:101–107

    Article  CAS  PubMed  Google Scholar 

  32. Gemma M, Beretta L, De Vitis A et al (1998) Complications of internal jugular vein retrograde catheterization. Acta Neurochir Suppl 71:320–323

    CAS  PubMed  Google Scholar 

  33. Kiening KL, Unterberg AW, Bardt TF et al (1996) Monitoring of cerebral oxygenation in patients with severe head injuries: brain tissue PO2 versus jugular vein oxygen saturation. J Neurosurg 85:751–757. doi:10.3171/jns.1996.85.5.0751

    Article  CAS  PubMed  Google Scholar 

  34. Gopinath SP, Valadka AB, Uzura M, Robertson CS (1999) Comparison of jugular venous oxygen saturation and brain tissue Po2 as monitors of cerebral ischemia after head injury. Crit Care Med 27:2337–2345

    Article  CAS  PubMed  Google Scholar 

  35. Lewis SB, Myburgh JA, Thornton EL, Reilly PL (1996) Cerebral oxygenation monitoring by near-infrared spectroscopy is not clinically useful in patients with severe closed-head injury: a comparison with jugular venous bulb oximetry. Crit Care Med 24:1334–1338

    Article  CAS  PubMed  Google Scholar 

  36. Robertson CS, Gopinath SP, Uzura M et al (1998) Metabolic changes in the brain during transient ischemia measured with microdialysis. Neurol Res 20(Suppl 1):S91–S94

    PubMed  Google Scholar 

  37. Coles JP, Minhas PS, Fryer TD et al (2002) Effect of hyperventilation on cerebral blood flow in traumatic head injury: clinical relevance and monitoring correlates. Crit Care Med 30:1950–1959. doi:10.1097/01.CCM.0000026331.91456.9A

    Article  CAS  PubMed  Google Scholar 

  38. Le Roux P, Menon DK, Citerio G et al (2014) Consensus summary statement of the international multidisciplinary consensus conference on multimodality monitoring in neurocritical care: a statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine. Intensive Care Med 40:1189–1209. doi:10.1007/s00134-014-3369-6

    Article  PubMed  Google Scholar 

  39. Stoquart-Elsankari S, Lehmann P, Villette A et al (2009) A phase-contrast MRI study of physiologic cerebral venous flow. J Cereb Blood Flow Metab 29:1208–1215. doi:10.1038/sj.jcbfm.jcbfm200929

    Article  PubMed  Google Scholar 

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Acknowledgments

The original research was conducted in the intensive care unit of Ospedale di Parma, Italy, by a group of enthusiast colleagues who co-authored the original paper. Everything was carried out in extra-hours in the absence of any financial support. To them (Franca Bridelli, Marisa Bacchi and Paolo Piazza, together with Alessandro Paparella and Paolo Zuccoli in memoriam) goes our gratitude. This research was supported by a departmental fund of Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico.

Conflicts of interest

The authors do not have conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Department of Physiopathology and Transplant, Milan University, Milan, Italy

    N. Stocchetti

  2. Department of Anesthesiology and Intensive Care, Neuro ICU, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via F Sforza 35, 20122, Milan, Italy

    N. Stocchetti & S. Magnoni

  3. Department of Neuroscience, IRCCS Istituto Mario Negri, Milan, Italy

    E. R. Zanier

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  1. N. Stocchetti
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  2. S. Magnoni
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  3. E. R. Zanier
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Correspondence to N. Stocchetti.

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Stocchetti, N., Magnoni, S. & Zanier, E.R. My paper 20 years later: cerebral venous oxygen saturation studied with bilateral samples in the internal jugular veins. Intensive Care Med 41, 412–417 (2015). https://doi.org/10.1007/s00134-015-3650-3

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