Monitoring of Jugular Venous Oxygen Saturation in Patients with Intracerebral Hematomas

Abstract

Perioperative treatment of patients with intracerebral hematomas is still a challenge in neurosurgical intensive care medicine. These patients often present with a chronically elevated blood pressure, and it might be surmised that regulation of cerebral blood flow is altered in these patients. Titration of arterial blood pressure is a special problem in these cases since normalization or lowering of blood pressure is essential to prevent rebleeding. As in other acute cerebral lesions, such as severe head injury, monitoring of cerebral blood flow is an unfulfilled request, especially in unconscious patients. Recently, monitoring of jugular venous oxygen saturation enabled at least an estimate of the quality of cerebral blood flow [1-3, 5]. This monitoring is performed by a fiberoptic catheter which is positioned in the jugular venous bulb [2]. Desaturation of cerebrovenous blood indicates an increased cerebral oxygen metabolism or a decreased cerebral blood flow [1, 3–5, 6]. Cerebrovenous oxygen saturation below 55% indicates a critically decreased cerebral blood flow desaturation below 50% definitely indicates cerebral ischemia [1, 3,6].