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NEUROSURGICAL ANESTHESIA

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

Arun K. Gupta, FRCA^*,, Peter J Hutchinson, FRCS, Pippa Al-Rawi, BSc, Sanjeeva Gupta, FRCA^*, Mike Swart, FRCA^*, Peter J Kirkpatrick, FRCS, David K. Menon, PhD, FRCA^*,, and Avijit K Datta, MD, MRCP

Departments of *Anesthesia, Neurosciences Critical Care, and Neurosurgery, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom

Address correspondence and reprint requests to Dr. A. K. Gupta, MBBS, FRCA, Department of Anaesthesia, Level 4, Addenbrooke’s Hospital, Cambridge CB2 2QQ, UK. Address e-mail to akg01@ globalnet.co.uk.

Jugular bulb oximetry is the most widely used method of monitoring cerebral oxygenation. More recently, measurement of brain tissue oxygenation has been reported in head-injured patients. We compared the changes in brain tissue oxygen partial pressure (PbO₂) with changes in jugular venous oxygen saturation (SjvO₂) in response to hyperventilation in areas of brain with and without focal pathology. Thirteen patients with severe head injuries were studied. A multiparameter sensor was inserted into areas of brain with focal pathology in five patients and outside areas of focal pathology in eight patients. A fiberoptic catheter was inserted into the right jugular bulb. Patients were hyperventilated in a stepwise manner from a PaCO₂ of approximately 35 mm Hg to a PaCO₂ of 22 mm Hg. There was no significant change in cerebral perfusion pressure or arterial partial pressure of oxygen with hyperventilation. In areas without focal pathology, there was a good correlation between changes in SjvO₂ and PbO₂ (SjvO₂ and PbO₂; r² = 0.69, P < 0.0001). In areas with focal pathology, there was no correlation between SjvO₂ and PbO₂ (r² =0.07, P = 0.23). In this study, we demonstrated that measurement of local tissue oxygenation can highlight focal differences in regional cerebral oxygenation that are disguised when measuring SjvO₂. Thus, monitoring of PbO₂ is a useful addition to multimodal monitoring of patients with traumatic head injury.

Implications: Brain oxygenation is currently monitored by using jugular bulb oximetry, which attracts a number of potential artifacts and may not reflect regional changes in oxygenation. We compared this method with measurement of brain tissue oxygenation using a multiparameter sensor inserted into brain tissue. The brain tissue monitor seemed to reflect regional brain oxygenation better than jugular bulb oximetry.

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