CO2 Reactivity and Autoregulation in Severe Head Injury: Bedside Assessment by Relative Changes in Arteriojugular Differences of Oxygen

  • Juan Sahuquillo
  • Marcelino Báguena
  • Laura Campos
  • Montserrat Olivé
Conference paper


It has been demonstrated both clinically and in experimental models that autoregulation and CO2 reactivity can be impaired independently of each other in many brain insults, the so-called dissociated vasoparalysis [1]. The theoretical combination of preserved CO2 reactivity and impaired or absent autoregulation can have many clinical implications in the overall daily management of brain-injured patients. To optimize their treatment, a bedside assessment of autoregulation and CO2 reactivity is desirable. In spite of some unresolved and controversial methodological problems, monitoring hemodynamic parameters through a reverse catheter with its tip in the jugular bulb is an easy way of monitoring brain metabolism and cerebral blood flow (CBF) coupling and in some cases of estimating CBF [2-4]. When the cerebral metabolic rate of oxygen (CMRO2) is constant, changes in arteriojugular differences of oxygen (AVDO2) reflect changes in CBF [5]. In this situation, relative changes in AVDO2 can be viewed as inverse changes in CBF and used as an evaluation method of CO2 reactivity and autoregulation. Our aims in this chapter are to use relative changes in AVDO2 after manipulations of mean arterial blood pressure and arterial pCO2 to assess CO2 reactivity and autoregulation in severe head injury patients.


Cerebral Blood Flow Cerebral Perfusion Pressure Mean Arterial Blood Pressure Cerebral Blood Volume Jugular Bulb 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Paulson OB, Olesen J, Christensen MS (1972) Restoration of autoregulation of cerebral blood flow by hypocapnia (abstr). Neurology 22: 286–293PubMedGoogle Scholar
  2. 2.
    Cruz J (1992) Jugular venous oxygen saturation monitoring (letter). J Neurosurg 77: 162–163PubMedGoogle Scholar
  3. 3.
    Cruz J, Gennarelli TA, Alves WM (1992) Continuous monitoring of cerebral oxygenation in acute brain injury: multivariate assessment of severe intracranial “plateau” wave. Case report. J Trauma 32: 401–403PubMedCrossRefGoogle Scholar
  4. 4.
    Schmidt JF, Waldemar G, Vorstrup S, Andersen AR, Gjerris F, Paulson OB (1990) Computerized analysis of cerebral blood flow autoregulation in humans: validation of a method for pharmacologic studies. J Cardiovasc Pharmacol 15: 983–988PubMedCrossRefGoogle Scholar
  5. 5.
    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
  6. 6.
    Goetting MG, Preston G (1990) Jugular bulb catheterization: experience with 123 patients. Crit Care Med 18: 1220–1223PubMedCrossRefGoogle Scholar
  7. 7.
    Olsen KS, Videbaek C, Agerlin N, Kroll M, Bogerasmussen T, Paulson OB, Gjerris F (1993) The effect of tirilazad mesylate (u74006 f) on cerebral oxygen consumption, and reactivity of cerebral blood flow to carbon dioxide in healthy volunteers. Anesthesiology 79: 666–671PubMedCrossRefGoogle Scholar
  8. 8.
    Davis SM, Ackerman RH, Correia JA, Alpert NM, Chang J, Buonanno F, Kelley RE, Rosner B, Taveras JM (1983) Cerebral blood flow and cerebrovascular CO2 reactivity in stroke-age normal controls. Neurology 33: 391–399PubMedGoogle Scholar
  9. 9.
    Kety SS, Schmidt CF (1948) The effects of active and passive hyperventilation on cerebral blood flow, cerebral oxygen consumption, cardiac output, and blood pressure of normal young men. J Clin Invest 25: 107–119CrossRefGoogle Scholar
  10. 10.
    Kety SS, Schmidt CF (1948) Effects of altered arterial tensions of carbon dioxide and oxygen on cerebral blood flow and cerebral oxygen consumption of normal young men. J Clin Invest 27: 484–492CrossRefGoogle Scholar
  11. 11.
    McHenry LC Jr, Slocum HC, Bivens HE, Mayes HA, Hayes CJ (1965) Hyperventilation in awake and anesthetized man. Effects on cerebral blood flow and cerebral metabolism. Arch Neurol 12: 270–277PubMedCrossRefGoogle Scholar
  12. 12.
    Enevoldsen EM, Jensen FT (1978) Autoregulation and CO2 responses of cerebral blood flow in patients with acute severe head injury. J Neurosurg 689: 698–703Google Scholar
  13. 13.
    Madsen FF (1990) Changes in regional cerebral blood flow after hyperventilation in the pig with an induced focal cerebral contusion. Acta Neurochir (Wien) 106: 164–169CrossRefGoogle Scholar
  14. 14.
    Muizelaar JP (1989) Induced arterial hypertension in the treatment of high ICP. In: Hoff JT (ed) Intracranial pressure VII. Springer-Verlag, Berlin Heidelberg, pp 508–510CrossRefGoogle Scholar
  15. 15.
    Bouma GJ, Muizelaar JP (1990) Relationship between cardiac output and cerebral blood flow in patients with intact and with impaired autoregulation. J Neurosurg 73: 368–374PubMedCrossRefGoogle Scholar
  16. 16.
    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
  17. 17.
    Bloor BM (1975) Cerebral hemodynamics: the effect of hypoxia on autoregulation and CO2 reactivity. In: Langfitt TW (ed) Cerebral circulation and metabolism. Springer-Verlag, Berlin Heidelberg, pp 55–58CrossRefGoogle Scholar
  18. 18.
    Shapiro W, Wasserman AJ, Patterson JL Jr (1965) Human cerebrovascular response time to elevation of arterial carbon dioxide tension. Arch Neurol 13: 130–138PubMedCrossRefGoogle Scholar
  19. 19.
    Robertson CS, Narayan RK, Gokaslan ZL, Pahwa R, Grossman RG, Caram P, Allen E (1989) Cerebral arteriovenous oxygen difference as an estimate of cerebral blood flow in comatose patiens. J Neurosurg 70: 222–230PubMedCrossRefGoogle Scholar
  20. 20.
    Vonhelden A, Schneider GH, Unterberg A, Lanksch WR (1993) Monitoring of jugular venous oxygen saturation in comatose patients with subarachnoid haemorrhage and intracerebral haematomas. Acta Neurochir (Suppl) 59: 102–106Google Scholar
  21. 21.
    Edvinsson L, MacKenzie ET, McCulloch J (1993) Disturbed cerebral autoregulation. In: Edvinsson L (ed) Cerebral blood flow and metabolism. Raven, New York, pp 599–609Google Scholar
  22. 22.
    Muizelaar JP, Becker DP, Lutz HA (1985) Present application and future promise of cerebral blood flow monitoring in head injury. In: Dacey RG (ed) Trauma of the central nervous system. Raven, New York, pp 91–102Google Scholar

Copyright information

© Springer-Verlag Tokyo 1995

Authors and Affiliations

  • Juan Sahuquillo
    • 1
  • Marcelino Báguena
    • 2
  • Laura Campos
    • 2
  • Montserrat Olivé
    • 3
  1. 1.Department of NeurosurgeryVall d’Hebron University HospitalBarcelonaSpain
  2. 2.Department of Neurotraumatology Intensive Care UnitVall d’Hebron University HospitalBarcelonaSpain
  3. 3.Anesthesiology DepartmentVall d’Hebron University HospitalBarcelonaSpain

Personalised recommendations