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Jugular bulb catheterization does not increase intracranial pressure
1Department of Pediatrics, Henry Ford Hospital, Detroit, Michigan.
Insights
Jugular bulb catheterization (JBC) safely monitors brain oxygen delivery. This study found JBC does not worsen intracranial pressure (ICP) in pediatric patients, alleviating concerns about venous obstruction.
Area of Science:
- Neurology
- Critical Care Medicine
- Vascular Surgery
Background:
- Jugular bulb catheterization (JBC) is crucial for assessing global oxygen delivery adequacy in brain-injured patients.
- Concerns exist that JBC may cause or worsen intracranial hypertension (ICP) due to potential venous obstruction.
- Physician reluctance to perform JBC in brain-injured patients stems from these safety concerns.
Purpose of the Study:
- To evaluate the impact of jugular bulb catheterization (JBC) on intracranial pressure (ICP) in pediatric patients.
- To determine if JBC exacerbates elevated ICP or causes venous obstruction.
- To assess the safety of JBC in critically ill pediatric patients.
Main Methods:
- 37 pediatric patients with jugular bulb catheters and ICP monitoring were studied.
- ICP was monitored during JBC in 28 patients.
- Jugular vein compression (ipsilateral, contralateral, bilateral) was performed post-JBC to assess vessel patency and ICP changes.
Main Results:
- Mean ICP remained stable post-JBC (17.2 +/- 5.1 torr) compared to pre-JBC (17.3 +/- 5.1 torr).
- Jugular vein compression resulted in minimal ICP increases (max 2 torr in one patient), with some patients showing decreased ICP.
- No correlation was found between ICP rise, catheterization duration, or precompression ICP levels.
Conclusions:
- Jugular bulb catheterization (JBC) does not appear to aggravate elevated intracranial pressure (ICP) in pediatric patients.
- The procedure does not provide evidence of significant jugular venous obstruction.
- JBC can be safely performed in brain-injured patients without worsening ICP.
Abstract:
Cerebral venous monitoring through jugular bulb catheterization (JBC) allows assessment of global oxygen delivery adequacy. Because of concern that venous obstruction by catheterization may cause or exacerbate intracranial hypertension, physicians are reluctant to puncture this vessel in brain-injured patients. We evaluated the impact of JBC on intracranial pressure (ICP). 37 consecutive pediatric patients with jugular bulb catheters and ICP monitoring were studied. ICP was monitored in 28 patients during JBC. Also immediately after JBC and daily thereafter the contralateral, ipsilateral, and bilateral jugular veins were compressed in all 37 patients to assess patency of these vessels. Change in ICP was noted. If ICP increased more than 5 torr, compression was stopped. Preinsertion ICP was 17.3 +/- 5.1 and postinsertion 17.2 +/- 5.1 torr. The maximum rise in ICP was 2 torr in a single patient while 6 others had a decrease in ICP. 120 compression tests were performed. Compression ipsilateral to the catheter caused the ICP to rise from 16.0 +/- 4.3 to 18.4 +/- 4.4 torr, and in contralateral compression 15.9 +/- 4.2 to 17.0 +/- 4.4. Neither the duration of catheterization nor the precompression ICP correlated with the rise in ICP. These data revealed no evidence of jugular venous obstruction in the catheterized vessel. We conclude that JBC can be performed in patients without aggravating an elevated ICP.