Jmk. Lam et al., CEREBRAL VENOUS OXYGEN-SATURATION MONITORING - IS DOMINANT JUGULAR BULB CANNULATION GOOD ENOUGH, British journal of neurosurgery, 10(4), 1996, pp. 357-364
Venous oxygen saturation at the clinically dominant jugular bulb (SjO(
2)) and that at the confluence of the cerebral sinuses (SCCSO2) were c
ompared by direct simultaneous blood sampling of 13 severely head inju
red patients. The side of dominant jugular bulb (JB) was determined by
neck compression test. The right side was chosen if the test was equi
vocal. In effect, the right side was cannulated in all cases. Subseque
nt angiography showed that two of the 13 cases were left side dominant
. In all, 176 pairs of blood samples were analysed. Correspondence rat
es (the difference between each pair of blood samples being less than
4% of oxygen saturation) for individual case were good (80-100%) in ni
ne cases including one case with left side dominance. Correspondence r
ates were moderate in two cases (50 and 56%); the differences were not
clinically significant. In the remaining two cases, including one wit
h left side dominance, the correspondence rates were poor (0 and 4%, r
espectively); SCCSO2 was always lower than SjO(2); median differences
were 13.4 and 23.1%. Ischaemia in the cerebral hemispheres would have
been underestimated if management were based on SjO(2). Monitoring at
the dominant JB accurately reflected the global and hemispheric cerebr
al oxygenation in 11/13 of cases. Monitoring at the non-dominant JB is
not recommended.