[Global systems for monitoring cerebral hemodynamics in the neurocritical patient: basic concepts, controversies and recent advances in measuring jugular bulb oxygenation].
Because of the importance of hypoxic/ischemic phenomena in head-injured patients, brain monitoring in these patients should be complemented by systems providing information on cerebral blood flow and metabolism. Indirect estimations of cerebral blood flow have been obtained from blood extracted from the jugular bulb, as a special bedside application of the Fick's principle to the brain. In the last few years, the use of jugular oximetry techniques has become routine in centers treating head-injured and other neurocritical patients such as those presenting subarachnoid hemorrhage or malignant middle cerebral artery infarction. The experience acquired in the use of these techniques, as well as the introduction of new neuromonitoring systems, have deepened our understanding of the information gained and have enabled more precise definition of their indications and limitations. This review describes the basic concepts underlying the use of jugular oximetry techniques in the neurocritical patient. We also explain the reasons why several variables derived from jugular blood such as arterio-jugular differences of lactate (AVDL) or the lactate-oxygen index (LOI) do not provide accurate information on brain metabolism.
Poca
M A
MA
Servicio de Neurocirugía, Hospital Universitario Vall d'Hebron. Universidad Autónoma de Barcelona.
Sahuquillo
J
J
Monforte
R
R
Vilalta
A
A
D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging; D001930:Brain Injuries / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*; D002404:Catheterization; D003422:Critical Care / Q000379:methods*; D005924:Glomus Jugulare / Q000378:metabolism* / Q000503:physiopathology*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D007601:Jugular Veins / Q000601:surgery; D010092:Oximetry / Q000379:methods*; D010100:Oxygen / Q000378:metabolism*; D010101:Oxygen Consumption; D014057:Tomography, X-Ray Computed
D010100:Oxygen