Restoration and maintenance of end-organ oxygen delivery are fundamental goals of
critical care medicine.
1.
Measuring mixed or central venous oxygen saturation allows the adequacy of systemic
oxygen delivery to be estimated. When oxygen delivery is insufficient to meet metabolic
demand, the fraction of arterial oxygen extracted and utilized by tissue increases
and venous oxygen saturation falls, eventually heralding cellular hypoxia, anaerobic
metabolism, and organ damage. While systemic venous saturation monitoring has a biological
rationale and face validity, randomized controlled trials have failed to demonstrate
benefit to patient centered outcomes.
2.
,
3.
This may be explained in part by complexity identifying the correct underlying pathophysiologic
cause(s) of abnormal values.
4.
Thus, there remains great interest in pushing oxygen monitoring to the level of the
end organs that drive clinical outcomes.
5.
,
6.
Brain injury is the primary determinant of outcome in comatose patients resuscitated
from out-of-hospital cardiac arrest (OHCA), and prevention of secondary brain injury
may save lives and improve quality of recovery.
7.
Akin to systemic venous oxygen monitoring, it is possible that insight into the dynamics
of cerebral oxygen delivery and consumption can be gained by sampling cerebral venous
outflow at the jugular bulb.
8.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ResuscitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Need for oxygen enrichment in myocardial infarction, shock and following cardiac arrest.Acta Anaesthesiol Scand Suppl. 1968; 29: 127-145
- Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial.Lancet. 2005; 366: 472-477
- A randomised, controlled trial of the pulmonary artery catheter in critically ill patients.Intensive Care Med. 2002; 28: 256-264
- Effect of measurement error on calculated variables of oxygen transport.J Appl Physiol. 1985; 1996: 559-563
- The microcirculation as a functional system.Crit Care. 2005; 9: S3-S8
- Moving from macro- to microcirculation in head injury.Crit Care Med. 2004; 32: 1429-1430
- Clinical pathophysiology of hypoxic ischemic brain injury after cardiac arrest: a “two-hit” model.Crit Care. 2017; 21: 90
- Cerebrovenous oxygen saturation monitoring: practical considerations and clinical relevance.Intensive Care Med. 2000; 26: 1028-1036
- Elevated jugular venous oxygen saturation after severe head injury.J Neurosurg. 1999; 90: 9-15
- Cerebral tissue PO2 and SjvO2 changes during moderate hyperventilation in patients with severe traumatic brain injury.J Neurosurg. 2002; 96: 97-102
- Monitoring of cerebral oxygenation in patients with severe head injuries: brain tissue PO2 versus jugular vein oxygen saturation.J Neurosurg. 1996; 85: 751-757
- Measuring brain tissue oxygenation compared with jugular venous oxygen saturation for monitoring cerebral oxygenation after traumatic brain injury.Anesth Analg. 1999; 88: 549-553
- Elevated jugular venous oxygen saturation after cardiac arrest.Resuscitation. 2021; 169: 215-219
- Effects of propofol on cerebral blood flow and the metabolic rate of oxygen in humans.Acta Anaesthesiol Scand. 2002; 46: 831-835
- The effect of temperature on cerebral metabolism and blood flow in adults during cardiopulmonary bypass.J Thorac Cardiovasc Surg. 1992; 103: 549-554
- Electroencephalographic periodic discharges and frequency-dependent brain tissue hypoxia in acute brain injury.JAMA Neurol. 2017; 74: 301-309
- The burden of brain hypoxia and optimal mean arterial pressure in patients with hypoxic ischemic brain injury after cardiac arrest.Crit Care Med. 2019; 47: 960-969
- Cerebrospinal fluid is a significant fluid source for anoxic cerebral oedema.Brain. 2021;
- Brain vulnerability and viability after ischaemia.Nat Rev Neurosci. 2021; 22: 553-572
- No-reflow after cardiac arrest.Intensive Care Med. 1995; 21: 132-141
- Persistently altered brain mitochondrial bioenergetics after apparently successful resuscitation from cardiac arrest.J Am Heart Assoc. 2015; 4e002232
- Changes in cerebral oxygen consumption and high-energy phosphates during early recovery in hypoxic-ischemic piglets: a combined near-infrared and magnetic resonance spectroscopy study.Pediatr Res. 2009; 65: 181-187
- Targeting two different levels of both arterial carbon dioxide and arterial oxygen after cardiac arrest and resuscitation: a randomised pilot trial.Intensive Care Med. 2018; 44: 2112-2121
- Targeting low-normal or high-normal mean arterial pressure after cardiac arrest and resuscitation: a randomised pilot trial.Intensive Care Med. 2018; 44: 2091-2101
- Brain hypoxia is associated with neuroglial injury in humans post-cardiac arrest.Circ Res. 2021; 129: 583-597
- Goal-directed care using invasive neuromonitoring versus standard of care after cardiac arrest: a matched cohort study.Crit Care Med. 2021; 49: 1333-1346
- Glibenclamide and therapeutic hypothermia have comparable effect on attenuating global cerebral edema following experimental cardiac arrest.Neurocrit Care. 2018; 29: 119-127
- The aquaporin-4 inhibitor AER-271 blocks acute cerebral edema and improves early outcome in a pediatric model of asphyxial cardiac arrest.Pediatric Res. 2019; 85: 511-517
- Conivaptan, a selective arginine vasopressin V1a and V2 receptor antagonist attenuates global cerebral edema following experimental cardiac arrest via perivascular pool of aquaporin-4.Neurocrit Care. 2016; 24: 273-282
- Osmotherapy with hypertonic saline attenuates global cerebral edema following experimental cardiac arrest via perivascular pool of aquaporin-4.Crit Care Med. 2016; 44: e702-e710
Article info
Publication history
Published online: November 05, 2021
Accepted:
October 29,
2021
Received:
October 27,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Elevated jugular venous oxygen saturation after cardiac arrestResuscitationVol. 169
- PreviewWe performed a retrospective analysis of our earlier study on cerebral oxygenation monitoring by jugular venous oximetry (SjvO2) in patients of out-of-hospital cardiac arrest (OHCA). The study was focused on high SjvO2 values (≥75%) and their association with neurological outcomes and serum neuron-specific enolase (NSE) concentration.
- Full-Text
- Preview
