Clinical uses of SjO2 monitoring

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Continuous monitoring of jugular venous oximetry has been performed in intensive care, the operating room, and the neuroradiology suite to monitor patients with brain trauma, intracranial aneurysms, and arteriovenous malformations.

Episodes of jugular venous desaturation to below 50 per cent have been reported in neurosurgical patients in association with hyperventilation, vasospasm, and compromised cerebral perfusion pressure during intensive care ( Chanefa/ 1992)- In a study of 102 patients with severe brain injury, 76 episodes of desaturation below 50 per cent for more than 10 min were recorded and verified in 41 patients, mostly during the first 24 h of intensive care. When outcome was evaluated in 95 patients at 3 months using the Glasgow outcome scale against the number of desaturation episodes, mortalities for none, one, and more than one episode of desaturation were 18 per cent, 46 per cent, and 71 per cent respectively ( Robertson 1992)- Recent work by Deyne (personal communication) has shown that of 150

patients with severe brain trauma and extremely early SjO2 monitoring (mean 4.8 h post-trauma), 85 had episodes of jugular desaturation to below 55 per cent within the first 6 to 12 h of management. In 42 of these patients the cause was a low cerebral perfusion pressure secondary to low blood pressure (< 70 mmHg), while in 29

it was associated with excessive hyperventilation (PaCO2 < 30 mmHg).

The potential value of continuously monitoring SjO2 is early detection of cerebral hypoperfusion ( SjO2 < 50 per cent), both intraoperatively and in intensive care, so that appropriate action can be taken more readily. Clinically relevant perturbations of SjO2 occur in about 60 per cent of neurological operations. A protocol for use when SjO2 falls below 50 per cent in patients with severe brain trauma is shown in Table,...?.

Table 2 Protocol for use when SjO2 is less than 50 per cent

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