The clinical importance of bulbus juguli oxymetry

Objective

In our study, we attempted to determine those representative clinical parameters that most exactly correlate with the final outcome of intensive treatment requiring neurological (ischaemic and haemorrhagic stroke) and neurosurgical (subdural and epidural haematoma) cases.

Methods

We observed 27 patients retrospectively. The cohort was divided into a survivor group I (12 cases) and a non-survivor group II (15 cases). We introduced a central venous canule into the internal jugular vein in the direction of the bulbus juguli, and collected blood samples every 6 hours, at every significant alteration of physical status and at therapeutic intervention. We monitored the cerebral perfusion pressure (CPP) and intracranial pressure (ICP) continously, and measured the oxygen saturation of a blood sample from the bulbus juguli (SvjO₂) and the jugular arteriovenous lactate gap every 6 hours, and the GCS every 8 hours. We registrated the change of intracranial structure by computer tomography.

Results

In group II (non-survivors) the SvjO₂ and lactate gap values were 83.83 ± 6.6% and 0.43 ± 0.06 mmol/l, in group I (survivors) the respective values were 71.57 ± 6.26% and 0.2 ± 0.1 mmol/l. We could not find a patient in group II with a GCS higher than 5. There was no significant difference in ICP and CPP values between survivor and non-survivor groups (13.6 ± 2.4 mmHg and 72.3 ± 8.4 mmHg versus 16.4 ± 8.1 mmHg and 68.45 ± 4.6 mmHg).

Conclusion

The bulbus juguli oxymetry is an invasive but cheap, simple and with competent practical skills a safely applicable monitoring method for the judgement of cerebral oxygenisation. The SvjO₂ and lactate gap values were determinative in the aspect of final outcome.