Ultrasound is a reliable method for determining jugular bulb dominance

Despite widespread application of jugular oximetry devices, the optimal sid e to cannulate for monitoring cerebral oxygenation is controversial. For mo st monitoring strategies, the dominant or larger internal jugular vein give s the most representative values for venous oxygen saturation. However, the re is little information on how to best determine the dominant side. The pu rpose of this study was to compare the results of an ultrasound examination to two other standard methods for determining the dominant internal jugula r vein, the jugular vein compression test and the computed tomographic (CT) approach. Seventeen patients with severe head injury (GCS <8) were studied . The ultrasound examination showed the mean internal diameter of the right and the left internal jugular veins to be 1.27 cm (standard deviation [SD] 0.16 cm) and 1.21 cm (SD 0.36 cm), respectively. The right internal jugula r vein was larger than the left in 11 (65%) of the patients. The diameter o f the dominant or larger internal jugular veins were 1.44 cm (SD = 0.22), c ompared with 1.04 cm (SD = 0.18) on the opposite side (P < .05). The result s of the ultrasound method were in agreement with the CT scan method in 94% of the comparisons and with the jugular vein compression test in 82% of co mparisons. These studies demonstrate that the ultrasound method provides us eful information about the side of the dominant cerebral venous drainage, c omparable to other standard methods, without the need for a CT scan or mani pulation of intracranial pressure.