Jugular Bulb Monitoring of Cerebral Oxygen Metabolism in Severe Head Injury: Accuracy of Unilateral Measurements
To investigate the accuracy of unilateral jugularvenous monitoring, we performed bilateral jugularvenous monitoring in 22 comatose head injured patients. Fiberoptic catheters were placed upstream in both internal jugular veins and advanced into the jugula
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© Springer-Verlag 1998
Jugular Bulb Monitoring of Cerebral Oxygen Metabolism in Severe Head Injury: Accuracy of Unilateral Measurements C. Metz\ M. Holzschuh 2, T. Bein l , B. Kallenbach\ and K. Taeger l Departments of I Anesthesiology and 'Neurosurgery, University Hospital of Regensburg, Federal Republic of Germany
Summary To investigate the accuracy of unilateral jugularvenous monitoring, we performed bilateral jugularvenous monitoring in 22 comatose head injured patients. Fiberoptic catheters were placed upstream in both internal jugular veins and advanced into the jugular bulbs. Arterial and bilateral jugularvenous blood samples were obtained simultaneously for in vitro determination of jugularvenous oxygen saturation (SJO,), arterial minus jugularvenous lactate content difference (AJDL) and modified lactate-oxygen-index (mLOI). Ischemia was assumed, if one of the following pathologies occured at least unilaterally: SJO, < 55%, AJDL < -0.37 mmol/L, mLOI > 0.08. The mean and maximum bilateral SJ0 2 differences varied between 1.4% to 21.0%, and 8.1 % to 44.3% respectively. The bias and limits of agreement (mean differences ±2SD) between paired samples were -0.4% ± 12.8%. Regarding AJDL bias and limits of agreement were 0.01 mmol/L ± 0.18 mmol/L. At best 87% of defined ischemic events could be evaluated by monitoring at the side of predominant lesion or, in diffuse injuries, at the side of the larger jugular foramen in CT scan (CT approach). We conclude. due to the wide limits of agreement in bilateral SJO, and AJDL the reliability of unilateral jugularvenous monitoring in patients with intracranial pathology is questionable. For diagnosing ischemia the CT approach has the highest sensitivity and is therefore recommended. Keywords: Jugular bulb; oxygen metabolism.
Introduction Monitoring of global cerebral hemodynamics and metabolism based on the Fick principle provided a lot of information concerning the pathophysiology of severe head injuries and has become an important tool for clinical management. Cerebral venous blood samples for oxygen saturation monitoring as well as for all derived calculations are usually obtained from unilateral jugular bulb catheterization. However, as recently demonstrated, marked differences can occur in patients suffering from severe head injuries [14].
To investigate the accuracy of unilateral jugularvenous monitoring and to determine the appropriate side, we performed bilateral jugularvenous monitoring in 22 comatose head injured patients.
Materials and Methods After approval by our local ethics committee, 22 patients with Glasgow Coma Scale (GCS) scores
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