Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, Ostrava, Czech Republic.
Department of Anaesthetics, Yeovil Hospital, Greater Kingston, Somerset, BA21 4AT, UK.
J Clin Monit Comput. 2021 Aug;35(4):741-748. doi: 10.1007/s10877-020-00530-x. Epub 2020 May 20.
Cerebral protection against secondary hypoxic-ischemic brain injury is a key priority area in post-resuscitation intensive care management in survivors of cardiac arrest. Nevertheless, the current understanding of the incidence, diagnosis and its' impact on neurological outcome remains undetermined. The aim of this study was to evaluate jugular bulb oximetry as a potential monitoring modality to detect the incidences of desaturation episodes during post-cardiac arrest intensive care management and to evaluate their subsequent impact on neurological outcome. We conducted a prospective, observational study in unconscious adult patients admitted to the intensive care unit who had successful resuscitation following out of hospital cardiac arrest of presumed cardiac causes. All the patients were treated as per European Resuscitation Council 2015 guidelines and they received jugular bulb catheter. Jugular bulb oximetry measurements were performed at six hourly intervals. The neurological outcomes were evaluated on 90th day after the cardiac arrest by cerebral performance categories scale. Forty patients met the eligibility criteria. Measurements of jugular venous oxygen saturation were performed for 438 times. Altogether, we found 2 incidences of jugular bulb oxygen saturation less than 50% (2/438; 0.46%), and 4 incidences when it was less than 55% (4/438; 0.91%). The study detected an association between SjVO and CO (r = 0.26), each 1 kPa increase in CO led to an increase in SjvO by 3.4% + / - 0.67 (p < 0.0001). There was no association between SjvO and PaO or SjvO and MAP. We observed a statistically significant higher mean SjvO (8.82% + / - 2.05, p < 0.0001) in unfavorable outcome group. The episodes of brain hypoxia detected by jugular bulb oxygen saturation were rare during post-resuscitation intensive care management in out of hospital cardiac arrest patients. Therefore, this modality of monitoring may not yield any additional information towards prevention of secondary hypoxic ischemic brain injury in post cardiac arrest survivors. Other factors contributing towards high jugular venous saturation needs to be considered.
脑保护以预防继发缺氧缺血性脑损伤是心脏骤停后复苏后重症监护管理的一个关键重点领域。然而，目前对发病率、诊断及其对神经结局的影响的理解仍不确定。本研究的目的是评估颈静脉球血氧饱和度作为一种潜在的监测方式，以检测心脏骤停后重症监护管理期间饱和度降低事件的发生率，并评估其对神经结局的后续影响。我们进行了一项前瞻性、观察性研究，纳入无意识的成年患者，这些患者在院外心脏骤停后成功复苏，病因推测为心脏原因。所有患者均按照 2015 年欧洲复苏委员会指南进行治疗，并接受颈静脉球导管。每 6 小时进行一次颈静脉球血氧饱和度测量。心脏骤停后第 90 天通过脑功能分类量表评估神经结局。40 名患者符合入选标准。共进行了 438 次颈静脉血氧饱和度测量。总共发现 2 例颈静脉球血氧饱和度低于 50%（2/438；0.46%），4 例低于 55%（4/438；0.91%）。该研究发现 SjVO 与 CO 之间存在关联（r=0.26），CO 每增加 1kPa，SjvO 增加 3.4%+/-0.67（p<0.0001）。SjvO 与 PaO 或 SjvO 与 MAP 之间无关联。我们观察到不良结局组的平均 SjvO 更高（8.82%+/-2.05，p<0.0001）。在院外心脏骤停患者的复苏后重症监护管理期间，通过颈静脉球血氧饱和度检测到的脑缺氧发作很少见。因此，这种监测方式可能无法提供任何关于预防心脏骤停后幸存者继发缺氧缺血性脑损伤的额外信息。需要考虑其他导致高颈静脉饱和度的因素。
