Skip to main content Accessibility help
Hostname: page-component-5d6d958fb5-jkwcl Total loading time: 0.344 Render date: 2022-11-27T09:17:36.758Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "displayNetworkTab": true, "displayNetworkMapGraph": false, "useSa": true } hasContentIssue true

Jugular Bulb Oximetry for Prediction of Vasospasm Following Subarachnoid Hemorrhage

Published online by Cambridge University Press:  02 December 2014

Navraj S. Heran
Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
Stephen J. Hentschel
Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
Brian D. Toyota
Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
Rights & Permissions[Opens in a new window]


HTML view is not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Cerebral vasospasm adversely impacts the outcome of those suffering aneurysmal subarachnoid hemorrhage (SAH). Prediction of vasospasm could improve outcomes. We hypothesized that preclinical vasospasm would be heralded by an increase in cerebral oxygen extractions (AVDO2) which could be detected by jugular bulb oximetry. A pilot study was conducted to address this hypothesis.


Fourteen consenting patients with aneurysmal SAH, undergoing early surgery, were entered into the study. Four patients were withdrawn from the study secondary to failure of catheters or religious belief. At the time of craniotomy, a jugular bulb catheter was placed. Post-operatively, arterial and jugular bulb blood samples were taken every 12 hours to calculate AVDO2. As this was an observational study, no change in management occurred based on measurements.


Four of 10 patients had clinical vasospasm. These patients had a significant rise in AVDO2 approximately one day prior to the onset of neurologic deficits (P<0.001). Symptoms resolved along with a significant improvement in AVDO2 on instituting hypertensive, hemo-dilutional, and hypervolemic therapy in these patients. The six patients who did not exhibit clinical vasospasm did not demonstrate significant rise in AVDO2.


Jugular bulb oximetry is simple and cost effective. Increases in AVDO2 using this technique were predictive of clinically evident vasospasm in the subsequent hours to days. This investigation supports a larger study to assess the utility of jugular bulb oximetry in predicting vasospasm in aneurysmal SAH.

Research Article
Copyright © The Canadian Journal of Neurological 2004


1.Dietrich, HH, Dacey, RG Jr.Molecular keys to the problems ofcerebral vasospasm. Neurosurgery 2000;46(3):517530.CrossRefGoogle Scholar
2.Schucknecht, B, Fandino, J, Yuksel, C, Yonekawa, Y, Valavanis, A.Endovascular treatment of cerebral vasospasm: assessment of treatment effect by cerebral angiography and transcranial Doppler sonography. Neuroradiology 1999;41:453462.CrossRefGoogle Scholar
3.Charpentier, C, Audibert, G, Guillemin, F, et al.Multivariate analysisof predictors of cerebral vasospasm occurrence after aneurysmal subarachnoid hemorrhage. Stroke 1999;30(7):14021408.CrossRefGoogle Scholar
4.Papavasiliou, AK, Harbaugh, KS, Birkmeyer, NJ, et al.Clinicaloutcomes of aneurysmal subarachnoid hemorrhage patients treated with oral diltiazem and limited intensive care management. Surg Neurol 2001;55(3):138146; discussion 146¬147.CrossRefGoogle Scholar
5.Turjman, F, Mimon, S, Yilmaz, H. [Epidemiology, clinical study andpathology of vasospasm]. J Neuroradiol 1999;26(1 Suppl):S10-S16.Google Scholar
6.Fisher, CM, Kistler, JP, Davis, JM.Relation of cerebral vasospasm tosubarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 1980;6(1):19.CrossRefGoogle Scholar
7.Rordorf, G, Koroshetz, WJ, Copen, WA, et al.Diffusion-andperfusion-weighted imaging in vasospasm after subarachnoidhemorrhage. Stroke 1999;30(3):599605.CrossRefGoogle Scholar
8.Busch, E, Beaulieu, C, de Crespigny, A, Moseley, ME.Diffusion MRimaging during acute subarachnoid hemorrhage in rats. Stroke 1998;29(10):21552161.CrossRefGoogle Scholar
9.Rowe, J, Blamire, AM, Domingo, Z, et al.Discrepancies betweencerebral perfusion and metabolism after subarachnoid haemorrhage:a magnetic resonance approach. J NeurolNeurosurg Psychiatry 1998;64(1):98103.CrossRefGoogle ScholarPubMed
10.Powsner, RA, O’Tuama, LA, Jabre, A, Melhem, ER.SPECT imagingin cerebral vasospasm following subarachnoid hemorrhage. JNucl Med 1998;39(5):765769.Google Scholar
11.Egge, A, Waterloo, K, Sjoholm, H, et al.Prophylactic hyperdynamicpostoperative fluid therapy after aneurysmal subarachnoid hemorrhage: a clinical, prospective, randomized, controlledstudy. Neurosurgery 2001;49(3):593605; discussion 605-606.Google Scholar
12.Gibbs, EL, Gibbs, FA.The cross section areas of the vessels that formthe torcular and the manner in which blood is distributed to the right and to the left lateral sinus. Anat Rec 1934;54:419.CrossRefGoogle Scholar
13.Fandino, J, Kaku, Y, Schuknecht, B, Valavanis, A, Yonekawa, Y.Improvement of cerebral oxygenation patterns and metabolic validation of superselective intraarterial infusion of papaverine for the treatment of cerebral vasospasm. J Neurosurg 1998;89(1):93100.CrossRefGoogle ScholarPubMed
14.Kassell, NF, Helm, G, Simmons, N, Phillips, CD, Cail, WS.Treatmentof cerebral vasospasm with intra-arterial papaverine. J Neurosurg 1992;77(6):848852.CrossRefGoogle Scholar
15.Firlik, AD, Kaufmann, AM, Jungreis, CA, Yonas, H.Effect oftransluminal angioplasty on cerebral blood flow in the management of symptomatic vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg 1997;86(5):830839.CrossRefGoogle ScholarPubMed
16.Levy, ML, Giannotta, SL.Cardiac performance indices duringhypervolemic therapy for cerebral vasospasm. J Neurosurg 1991;75(1):2731.CrossRefGoogle ScholarPubMed
17.Voldby, B, Enevoldsen, EM, Jensen, FT.Regional CBF,intraventricular pressure, and cerebral metabolism in patients withrupturedintracranialaneurysms.J Neurosurg 1985;62(1):4858.CrossRefGoogle Scholar
18.Jakobsen, M, Overgaard, J, Marcussen, E, Enevoldsen, EM.Relationbetween angiographic cerebral vasospasm and regional CBF in patients with SAH. Acta Neurol Scand 1990;82(2):109115.CrossRefGoogle Scholar
19.Carpenter, DA, Grubb, RL Jr, Tempel, LW, Powers, WJ. Cerebraloxygen metabolism after aneurysmal subarachnoid hemorrhage. J Cereb Blood Flow Metab 1991;11(5):837844.CrossRefGoogle Scholar
20.Grubb, RL Jr, Raichle, ME, Eichling, JO, Gado, MH.Effects ofsubarachnoid hemorrhage on cerebral blood volume, blood flow, and oxygen utilization in humans. J Neurosurg 1977;46(4):446453.CrossRefGoogle ScholarPubMed
21.Cruz, J.The first decade of continuous monitoring of jugular bulboxyhemoglobin saturation: management strategies and clinical outcome. Crit Care Med 1998;26:344351.CrossRefGoogle Scholar
22.Coplin, WM, O’Keefe, GE, Grady, MS, et al.Thrombotic, infectious,and procedural complications of the jugular bulb catheter in the intensive care unit. Neurosurgery 1997;41(1):101107; discussion 107-109.CrossRefGoogle Scholar
23.Kety, SS, Schmidt, CF.The nitrous oxide method for the quantitativedetermination of cerebral blood flow in man: theory, procedure and normal values. J Clin Invest 1948;27:476483.CrossRefGoogle ScholarPubMed
24.Robertson, CS, Narayan, RK, Gokaslan, ZL, et al.Cerebralarteriovenous oxygen difference as an estimate of cerbral blood flow in comatose patients. J Neurosurg 1989;70:222230.CrossRefGoogle Scholar
25.Jones, TH, Morawetz, RB, Crowell, RM.Thresholds of focal cerebralischemia in awake monkeys. J Neurosurg 1981;54:773782.CrossRefGoogle Scholar
26.Hossman, KA, Schuier, FJ.Experimental braininfarcts in cats. 1.Pathophysiolgoical observations. Stroke 1980;11:583592.CrossRefGoogle Scholar
27.Schneider, GH, von Helden, A, Lanksch, WR, Unterberg, A.Continuous monitoring of jugular bulb oxygen saturation in comatose patients – therapeutic implications. Acta Neurochir 1995;134(1-2):7175.CrossRefGoogle ScholarPubMed
28.Lassen, NA.The luxury-perfusion syndrome and its possible relationto acute metabolic acidosis localized within the brain. Lancet 1996;2:11131115.Google Scholar
29.von Helden, A, Schneider, GH, Unterberg, A, Lanksch, WR.Monitoring of jugular venous oxygen saturation in comatose patients with subarachnoid hemorrhage and intracerebral hematomas. Acta Neurochir Suppl (Wien) 1993;59:102106.Google Scholar
30.Gibbs, EL, Lennox, WG, Nims, LF, Gibbs, FA.Arterial and cerebralvenous blood. Arterial-venous difference in man. J Biol Chem 1942;144:325332.Google Scholar
31.Kawamura, S, Sayama, I, Yasui, N, Uemura, K.Sequential changes incerebral blood flow and metabolism in patients with subarachnoid haemorrhage. Acta Neurochir 1992;114(1-2):12332.CrossRefGoogle Scholar
32.Miller, JI, Chou, MW, Capocelli, A, et al.Continuous intracranialmultimodality monitoring comparing local cerebral blood flow, cerebral perfusion pressure, and microvascular resistance. Acta Neurochir Suppl (Wien) 1998;71:8284.Google ScholarPubMed
33.Hino, A, Mizukawa, N, Tenjin, H, et al.Postoperative hemodynamicand metabolic changes in patients with subarachnoidhemorrhage. Stroke 1989;20(11):15041510.CrossRefGoogle Scholar
34.Powers, WJ, Grubb, RL Jr, Baker, RP, Mintun, MA, Raichle, ME.Regional cerebral blood flow and metabolism in reversible ischemia due to vasospasm. Determination by positron emission tomography. J Neurosurg 1985;62(4):539546.CrossRefGoogle ScholarPubMed
35.Jakobsen, M, Enevoldsen, E, Bjerre, P.Cerebral blood flow andmetabolism following subarachnoid haemorrhage: cerebral oxygen uptake and global blood flow during the acute period inpatients with SAH. Acta Neurol Scand 1990;82(3):174182.CrossRefGoogle Scholar
36.Sheinberg, M, Kanter, MJ, Robertson, CS, et al.Continuousmonitoring of jugular venous oxygen saturation in head- injuredpatients. J Neurosurg 1992;76(2):212217.CrossRefGoogle Scholar
37.Coplin, WM, O’Keefe, GE, Grady, MS, et al.Accuracy of continuousjugular bulb oximetry in the intensive care unit. Neurosurgery 1998;42(3):5339; discussion 539-540.Google Scholar
38.Ritter, AM, Gopinath, SP, Contant, C, Narayan, RK, Robertson, CS.Evaluation of a regional oxygen saturation catheter for monitoring SjvO2 in head injured patients. J Clin Monit 1996;12(4):285291.Google ScholarPubMed
39.Shenkin, GA, Harmel, MH, Kety, SS.Dynamic anatomy of thecerebral circulation. Arch Neurol Psych 1948;60:240252.CrossRefGoogle Scholar
40.Matta, BF, Lam, AM.The rate of blood withdrawal affects theaccuracy of jugular venous bulb oxygen saturation measurements. Anesthesiology 1997;86(4):806808.CrossRefGoogle Scholar
41.Ogata, N, Mijake, H, Ogata, K, et al.Intraoperative monitoring duringcarotid cross-clamping with near infrared spectroscopy: a preliminary study. J Biomed Optics 1996;1(4):405413.CrossRefGoogle ScholarPubMed
42.Persson, L, Hillered, L.Chemical monitoring of neurosurgicalintensive care patients using intracerebral microdialysis. J Neurosurg 1992;76(1):7280.CrossRefGoogle ScholarPubMed
43.Meixensberger, J, Jager, A, Dings, J, Baunach, S, Roosen, K.Multimodal hemodynamic neuromonitoring – quality and consequences for therapy of severely head injured patients. Acta Neurochir Suppl 1998;71:260262.Google ScholarPubMed
You have Access
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Jugular Bulb Oximetry for Prediction of Vasospasm Following Subarachnoid Hemorrhage
Available formats

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

Jugular Bulb Oximetry for Prediction of Vasospasm Following Subarachnoid Hemorrhage
Available formats

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

Jugular Bulb Oximetry for Prediction of Vasospasm Following Subarachnoid Hemorrhage
Available formats

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *