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Intracranial Pressure and SvjO2

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Monitoring Technologies in Acute Care Environments

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Abstract

Intracranial pressure monitoring gives insight into pathophysiological derangement of intracerebral hemodynamics. It may be used to direct and titrate therapy targeted towards optimizing cerebral perfusion and oxygenation, by manipulation of water and blood content of the intracranial cavity. Noninvasive methods are increasingly investigated but suffer challenges in accuracy and pragmatic use. The various invasive approaches include direct monitoring of the ventricular system of the brain, which remains the gold standard. Intraparenchymal methods include a range of fiberoptic and piezoelectric transducers. Combination devices allow brain oxygen tension or brain compliance monitoring. Limitations revolve around the infection risk of the fluid channel in ventricular pressure transduction, as well as accuracy and drift problems in the parenchymal devices. Jugular bulb saturation monitoring (SvjO2) of the cranial venous outflow in combination with the Fick principle provides an estimate of the adequacy of cerebral perfusion to meet cerebral metabolic demand. With intermittent sampling and continuous catheter measurement techniques, it can also provide jugular bulb pressure estimates as well as arteriovenous difference in lactate. Its limitations reside in its averaging of cortical supply versus demand, which limits sensitivity to regional problems.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington School of Medicine, 325 Ninth Avenue, 359724, Seattle, WA, 98104, USA

    Nelson Nicolas Algarra MD & Michael J. Souter MB,ChB, FRCA

Authors
  1. Nelson Nicolas Algarra MD
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  2. Michael J. Souter MB,ChB, FRCA
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Corresponding author

Correspondence to Michael J. Souter MB,ChB, FRCA .

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Editors and Affiliations

  1. Departments of Anesthesiology, Surgery, and Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA

    Jesse M. Ehrenfeld

  2. Department of Anesthesiology and Perioperative Care, University of California, Irvine, Irvine, California, USA

    Maxime Cannesson

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Algarra, N.N., Souter, M.J. (2014). Intracranial Pressure and SvjO2. In: Ehrenfeld, J., Cannesson, M. (eds) Monitoring Technologies in Acute Care Environments. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8557-5_29

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  • DOI: https://doi.org/10.1007/978-1-4614-8557-5_29

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  • Publisher Name: Springer, New York, NY

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  • Online ISBN: 978-1-4614-8557-5

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