Korean J Crit Care Med.  2016 Aug;31(3):251-255. 10.4266/kjccm.2016.00143.

Brain Oxygen Monitoring via Jugular Venous Oxygen Saturation in a Patient with Fulminant Hepatic Failure

• Kim Y
• Kim CK
• Jung S
• Ko SB

• KMID: 2350910
• DOI: http://doi.org/10.4266/kjccm.2016.00143

Abstract

Fulminant hepatic failure (FHF) is often accompanied by a myriad of neurologic complications, which are associated with high morbidity and mortality. Although appropriate neuromonitoring is recommended for early diagnosis and to minimize secondary brain injury, individuals with FHF usually have a high chance of coagulopathy, which limits the ability to use invasive neuromonitoring. Jugular bulb venous oxygen saturation (JvOâ‚‚) monitoring is well known as a surrogate direct measures of global brain oxygen use. We report the case of a patient with increased intracranial pressure due to FHF, in which JvOâ‚‚ was used for appropriate brain oxygen monitoring.

Keyword

brain edema; liver failure, acute; hepatic encephalopathy; jugular vein; oxygen consumption

MeSH Terms

Brain Edema
Brain Injuries
Brain*
Early Diagnosis
Hepatic Encephalopathy
Humans
Intracranial Pressure
Jugular Veins
Liver Failure, Acute*
Mortality
Oxygen Consumption
Oxygen*
Oxygen

Figure

• 

  Fig. 1. (A) Initial brain-computed tomography (CT) scan did not show definite cerebral swelling. (B) Follow-up brain CT scan showed loss of gray- and white-matter attenuation differences, indicating cerebral swelling. (C) Neck X-ray shows a catheter in the right internal jugular vein (arrows). (D) Axial fluid-attenuation inversion recovery magnetic resonance imaging revealed high signal intensity lesions in the right temporal and bilateral insular cortex.

• 

  Fig. 2. Changes in continuously monitored jugular venous oxygen saturation (JvO2). With low JvO2 and brain swelling, patient was administered intermittent hypertonic saline at 11.7% and continuous hypothermia therapy (at 35°C and decreased decreased to 33°C) during 4 days (arrows).

Reference

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