Jugular Bulb Oxygen Saturation

USES

Jugular Bulb Oxygen Saturation = measure of oxygen delivery and extraction to the brain

  • assess information about cerebral metabolism and blood flow
  • neurosurgery
  • head injury
  • cardiopulmonary bypass

METHOD OF INSERTION AND/OR USE

  • Seldinger technique
  • insert on side of injury
  • retrograde passing of catheter into jugular bulb
  • can measure
  1. venous saturation (goal = 55-85%) – can be measured continuously
  2. PvO2
  3. lactate

OTHER INFORMATION

  • can be attached to a continuous monitor
  • can be inserted unilaterally or bilaterally
  • general use = to optimize blood flow and oxygenation to brain and decrease cerebral metabolic rate

Interpretation

  • hyperemic: > 75%
  • Normal range: 55-75%
  • Critical SjO2: 50-55%
  • Pathological: <50%

Approach to desaturation (< 50%)

  • check accuracy with co-oximetry reading
  • check ABG -> if PO2 low correct
  • check MAP -> if low correct
  • check Hb -> if low correct
  • check ICP -> if high, correct
  • check temperature -> if high, cool
  • check EEG activity to exclude fitting

Approach to Hyperaemia (> 75%)

  • check accuracy with co-oximetry reading
  • if increased CBF contributory -> check PCO2
  • if decreased cerebral oxygen consumption -> check ICP, consider CT

COMPLICATIONS

  • CVL insertion complications
  • only gives information of global cerebral metabolism not regional
  • if both cerebral blood flow and O2 consumption decrease then SjO2 may be unchanged
  • venous thrombosis -> infarction
  • no good data saying that this technique alters outcome

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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