Measuring Brain Tissue Oxygenation Compared with Jugular Venous Oxygen Saturation for Monitoring Cerebral Oxygenation After Traumatic Brain Injury

Cerebral oxygenation following decompressive hemicraniectomy for the treatment of refractory intracranial hypertension

“…Several converging lines of evidence show that this is a reliable and safe addition to monitoring strategies in the treatment of patients with brain injury. 13,14,22,25,32,71 In animal studies it had been shown that continuous measurement of brain tissue O 2 is associated with changes in blood oxygenation and ventilation and variations in ICP and CPP. 38 Clinical experience with brain tissue O 2 monitoring has been predominantly in patients with TBI, but there is now increasing experience in patients with SAH.…”

Neurointensive care biophysiological monitoring: Table 1

“…In the setting of high SjvO 2 and reduced CEO 2 , rather than targeting an arbitrary PaCO 2 , some have advocated hyperventilating until the jugular bulb oximetry values normalize 34 35. This is controversial, however, because jugular bulb oximetry is a monitor of global oxygenation and it is relatively insensitive in detecting focal areas that may be most at risk for secondary insults 36. There is evidence of hypoperfusion in focal brain tissue even when SjvO 2 is within normal limits 37.…”

Low brain tissue oxygen predicts poor outcome, but does it give insight to possible interventions?*

“…Could BNP its synthetic recombinant form nesiritide be utilized as a therapeutic agent in this population as it has been in patients with decompensated heart failure? In a recent randomized pilot study in patients with AMI without shock, aside from reducing Nt-proBNP levels suggesting a decrease in intracardiac pressures, neseritide administered for 5 days beginning at a mean of 33 hours after onset of symptoms improved neither the neurohumoral milieu nor left ventricular remodeling at 90 days (18). As neseritide also tended to decrease blood pressure and glomerular filtration rate, it is unlikely that this hormone could be considered as a therapeutic agent in CS.…”

“…Most trials comprised about 30 patients in each group so that most of these trials lacked the power to show differences in the critical outcome. Two meta-analyses (17,18), which included most of the same cases, have come to different conclusions. Marik and Zaloga (17) did not find any benefit from intestinal feed feeding, whereas Heyland et al (18) concluded that intestinal feeding reduced the risk of pneumonia and was also associated with better success of reaching nutritional goals.…”

“…Two meta-analyses (17,18), which included most of the same cases, have come to different conclusions. Marik and Zaloga (17) did not find any benefit from intestinal feed feeding, whereas Heyland et al (18) concluded that intestinal feeding reduced the risk of pneumonia and was also associated with better success of reaching nutritional goals. The difference is entirely due to the inclusion of one trial (5) in the analysis by Heyland et al The lack of agreement between the two metaanalyses suggests that the differences between the two routes of feeding may be relatively minor and variable.…”