Principles of SjO2 management

Normal values are approximately 65-70%. In the absence of anaemia and with maintenance of normal SaO2 values, values of SjO2 >75% suggest luxury perfusion or global infarction with oxygen not being utilised; values <54% correspond to cerebral hypoperfusion while values <40% suggest global ischaemia and are usually associated with increased cerebral lactate production. Knowledge of Sj02 allows optimisation of brain blood flow to avoid (i) either excessive or inadequate perfusion and (ii) iatrogenically induced hypoperfusion through treating raised intracranial pressure aggressively with diuretics and hyperventilation. Studies in trauma patients have found (i) a higher mortality with episodes of jugular venous desaturation and (ii) a significant relationship between cerebral perfusion pressure (CPP) and Sj02 when the CPP was <70mmHg. A falling Sj02 may be an indication to increase CPP though no prospective randomised trial has yet been performed to study the effect on outcome.

Approximately 85% of cerebral venous drainage passes down one of the internal jugular veins (usually the right). Sj02 usually represents drainage from both hemispheres and is equal on both sides; however, after focal injury, this pattern of drainage may alter.

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