Assessment of Cerebral Oxygen Balance During Deep Hypothermic Circulatory Arrest by Continuous Jugular Bulb Venous Saturation and Near-Infrared Spectroscopy

Objective: The purpose of this study was to compare jugular venous bulb saturation (SjvO₂) and regional cerebral oximetry (rSO₂) by near-infrared spectroscopy (NIRS) during procedures with deep hypothermic circulatory arrest (DHCA). Design: Prospective observational study. Setting: Academic hospital. Participants: Patients undergoing aortic reconstructive surgery with DHCA from July 2001 to January 2005. Intervention: The authors examined cerebral oxygenation by continuous NIRS monitoring and by blood gas analysis of intermittently sampled jugular bulb blood (SjvO₂). Data were obtained during various stages of the procedure in 29 patients. NIRS measurements were compared with SjvO₂. Measurements and Main Results: NIRS and SjvO₂ trends were similar. Overall, cerebral venous oxygen saturation obtained from NIRS was lower compared with SjvO₂ (p < 0.05), especially during periods of low temperature. The mean correlation between NIRS and SjvO₂ was 0.363, and the individual correlations varied from -0.11 to 0.91. The low mean correlation was because of a high degree of variability in the NIRS data between patients. Conclusion: It was concluded that NIRS does not closely correlate with SjvO₂ in this patient population. Cerebral oximetry measured by NIRS could not replace jugular bulb saturation as an intraoperative marker of adequate metabolic suppression.