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Continuous Monitoring of Jugular Bulb Oxygen Saturation in the Management of Patients with Severe Closed Head Injury

  • Yasufumi Mizutani
  • Tsuyoshi Katabami
  • Masahiko Udzura
  • Takeki Ogawa
  • Hiroaki Sekino
  • Yoshio Taguchi
  • Ikuo Yamanaka
Conference paper

Abstract

Continuous monitoring of intracranial pressure (ICP) is essential in the management of the patients with severe head injury, and various methods to decrease ICP have been utilized [1]. Hyperventilation, however, may occasionally cause inadequate cerebral perfusion, resulting in secondary brain damage in patients with increased ICP [2]. We have performed experimental and clinical studies using simultaneous monitoring of ICP and jugular bulb oxygen saturation (SjO2) with a fiberoptic catheter to evaluate dynamic changes in cerebral perfusion and cerebral metabolic rate, with the aim of finding an appropriate treatment strategy for patients with severe head injury [3]. On the basis of our previous data [3] and a review of the literature [4, 5], it was considered that a value for SjO2 less than 50% indicated hypoperfusion and a value more than 80% suggested hyperemia. We present herein our early experience of the management of severely head-injured patients by using simultaneous monitoring of ICP and SjO2 and discuss the treatment protocol we have developed.

Keywords

Continuous Monitoring Glasgow Coma Scale Score Severe Head Injury Cerebral Metabolic Rate Simultaneous Monitoring 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Taguchi Y, Ogawa T, Sekino H (1988) Brain injury and intracranial pressure. Clin Neurosci 6: 1118–1120Google Scholar
  2. 2.
    Obrist WD, Langfitt TW, Jaggi JL, Cruz J, Gennarelli TA (1984) Cerebral blood flow and metabolism in comatose patients with acute head injury. Relationship to intracranial hypertension. J Neurosurg 61: 241–253PubMedCrossRefGoogle Scholar
  3. 3.
    Katabami T (1993) The relationship between cerebral venous oxygen saturation and cerebral blood flow in focal brain injury: an experimental study. St Marianna Med J 21: 725–736Google Scholar
  4. 4.
    Gibbs EL, Lennox WG, Nims LF, Gibbs FA (1942) Arterial and cerebral venous blood. Arterial-venous differences in man. J Biol Chem 144: 325–332Google Scholar
  5. 5.
    Sheinberg M, Kanter MJ, Robertson CS, Contant CF, Narayan RJ, Grossman RG (1992) Continuous monitoring of jugular venous oxygen saturation in headinjured patients. J Neurosurg 76: 212–217PubMedCrossRefGoogle Scholar
  6. 6.
    Marshall LF, Marshall SB, Klauber MR, Clark MVB, Eisenberg HM, Jane JA, Luerssen TG, Marmarou A, Foulkes MA (1991) A new classification of head injury based on computerized tomography. J Neurosurg 75: S14–S20Google Scholar
  7. 7.
    Graham DI, Adams JH (1971) Ischemic brain damage in fatal head injuries. Lancet 1: 265–266PubMedCrossRefGoogle Scholar
  8. 8.
    Robertson CS, Grossman RG, Goodman JC, Narayan RK (1987) The predictive value of cerebral anaerobic metabolism with cerebral infarction after head injury. J Neurosurg 67: 361–368PubMedCrossRefGoogle Scholar
  9. 9.
    Andrews PJD, Dearden NM (1990) Validation of the Oximetrix III for continuous monitoring of jugular bulb oxygen saturation: comparison with IL 282 in vitro co-oximeter (abstrt). Br J Anaesth 64: 393–394Google Scholar
  10. 10.
    Cruz J, Miner ME, Allen SJ, Alves WM, Gennarelli TA (1990) Continuous monitoring of cerebral oxygenation in acute brain injury: injection of mannitol during hyperventilation. J Neurosurg 73: 725–730PubMedCrossRefGoogle Scholar
  11. 11.
    Astrup J, Sorensen PM, Sorensen HR (1981) Inhibition of cerebral oxygen and glucose consumption in the dog by hypothermia, pentobarbital, and lidocaine. Anesthesiology 55: 263–268PubMedCrossRefGoogle Scholar
  12. 12.
    Shiozaki T, Sugimoto H, Taneda M, Yoshida H, Imai A, Yoshioka T, Sugimoto T (1993) Effect of mild hypothermia on uncontrollable intracranial hypertension after severe head injury. J Neurosurg 79: 363–368PubMedCrossRefGoogle Scholar
  13. 13.
    Langfitt TW, Gennarelli TA, Obrist WD, Bruce DA, Zimmerman RA (1982) Prospects for the future in the diagnosis and management of head injury: pathophysiology, brain imaging, and population-based studies. Clin Neurosurg 29: 353–376PubMedGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 1995

Authors and Affiliations

  • Yasufumi Mizutani
    • 1
  • Tsuyoshi Katabami
    • 1
  • Masahiko Udzura
    • 1
  • Takeki Ogawa
    • 1
  • Hiroaki Sekino
    • 3
  • Yoshio Taguchi
    • 3
  • Ikuo Yamanaka
    • 2
  1. 1.Department of NeurosurgerySt. Marianna University School of MedicineAsahi-ku, YokohamaJapan
  2. 2.Department of Critical Care Medicine, Yokohama City Seibu HospitalSt. Marianna University School of MedicineAsahi-ku, YokohamaJapan
  3. 3.Division of Neurosurgery, The Second Department of SurgerySt. Marianna University School of MedicineAsahi-ku, YokohamaJapan

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