Raised Jugular Venous Pressure Intensifies Release of Brain Injury Biomarkers in Patients Undergoing Cardiac Surgery

Dąbrowski, Wojciech; Kotlinska, Edyta; Rzecki, Ziemowit; Czajkowski, Marek; Stadnik, Adam; Olszewski, K

doi:10.1053/j.jvca.2012.07.015

Cited by 12 publications

(6 citation statements)

References 36 publications

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“…It could be hypothesised that when the bloodstream is not able to flow out the brain due to uncertain causes, the venous stasis could increase the hydrostatic pressure in the inner ear and the hearing and vestibular systems 24,25. Furthermore, the venous congestion could impair the cerebral perfusion when the arterial tree is already damaged: the impairment in venous drainage can induce ischaemic-like lesions due to the induced venous desaturation, the altered lactates/pyruvates ratio and the reduced tissue oxygenation index [26][27][28]. Such conditions are all able to worsen the functionality of the structures of the inner ear that are particularly susceptible to flow variations and oxygenations features of the blood.…”

mentioning

confidence: 99%

Idiopathic sudden sensorineural hearing loss and ménière syndrome: The role of cerebral venous drainage

Ciccone

Scicchitano

Gesualdo

et al. 2017

Clinical Otolaryngology

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Objectives: To evaluate the influence of cerebral venous drainage on the pathogenesis of idiopathic sudden sensorineural hearing loss (ISSHL) and M eni ere syndrome (MD).Design: Observational, prospective, cohort study. Results: No morphological alterations were found both in patients and controls.There were no signs of stenosis, blocked flow, membranes, etc. We found lower minimum, mean and maximum velocities in distal IJVs (P = .019; P = .013; P = .022; respectively) and left VVs (P = .027; P = .008; P = .001; respectively) in supine (0°) position in both MD and ISSHL patients as compared to controls. The same was for orthostatic position (90°). We found negative correlations between the velocities in extracranial veins and PTA values: therefore, the worst the audiometric performance of the subjects, the lower the velocities in the venous cerebral drainage.Conclusions: Idiopathic sudden sensorineural hearing loss and M eni ere syndrome patients showed altered venous flow in IJVs and VVs as compared to controls, independently from posture. This different behavior of venous tone control can influence the ear performance and may have a role in the pathogenesis of both diseases.

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mentioning

confidence: 99%

Idiopathic sudden sensorineural hearing loss and ménière syndrome: The role of cerebral venous drainage

Ciccone

Scicchitano

Gesualdo

et al. 2017

Clinical Otolaryngology

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Section: Discussionmentioning

confidence: 52%

“…Elevated cerebral venous pressure increases the risk of cerebral injury and the release of blood-brain barrier biomarkers. 35,36 Similar hemoglobin signal variations have been described with somatic oximetry during venous occlusion of the upper extremity. 20 Combinations of mechanisms can occur, as seen in inferior vena cava venous cannula repositioning and acute right ventricular dysfunction.…”

Section: Anesthesia and Analgesiamentioning

confidence: 52%

Early Detection and Correction of Cerebral Desaturation With Noninvasive Oxy-Hemoglobin, Deoxy-Hemoglobin, and Total Hemoglobin in Cardiac Surgery: A Case Series

Calderone

Jarry

Couture

et al. 2022

Anesthesia &Amp; Analgesia

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Regional cerebral oxygen saturation (rSo 2 ) obtained from near-infrared spectroscopy (NIRS) provides valuable information during cardiac surgery. The rSo 2 is calculated from the proportion of oxygenated to total hemoglobin in the cerebral vasculature. Root O3 cerebral oximetry (Masimo) allows for individual identification of changes in total (ΔcHbi), oxygenated (Δo 2 Hbi), and deoxygenated (ΔHHbi) hemoglobin spectral absorptions. Variations in these parameters from baseline help identify the underlying mechanisms of cerebral desaturation. This case series represents the first preliminary description of Δo 2 Hbi, ΔHHbi, and ΔcHbi variations in 10 cardiac surgical settings. Hemoglobin spectral absorption changes can be classified according to 3 distinct variations of cerebral desaturation. Reduced cerebral oxygen content or increased cerebral metabolism without major blood flow changes is reflected by decreased Δo 2 Hbi, unchanged ΔcHbi, and increased ΔHHbi Reduced cerebral arterial blood flow is suggested by decreased Δo 2 Hbi and ΔcHbi, with variable ΔHHbi. Finally, acute cerebral congestion may be suspected with increased ΔHHbi and ΔcHbi with unchanged Δo 2 Hbi. Cerebral desaturation can also result from mixed mechanisms reflected by variable combination of those 3 patterns. Normal cerebral saturation can occur, where reduced cerebral oxygen content such as anemia is balanced by a reduction in cerebral oxygen consumption such as during hypothermia. A summative algorithm using rSo 2 , Δo 2 Hbi, ΔHHbi, and ΔcHbi is proposed. Further explorations involving more patients should be performed to establish the potential role and limitations of monitoring hemoglobin spectral absorption signals. (Anesth Analg 2022;135:1304-14) GLOSSARY ΔcHbi = index representing changes in the total (ΔHHbi + Δo 2 Hbi) hemoglobin component of the rSo 2 ; ΔHHbi = index representing changes in the deoxygenated hemoglobin component of the rSo 2 ; Δo 2 Hbi = index representing changes in the oxygenated hemoglobin component of the rSo 2 ; Cao 2 = arterial oxygen content; CBF = cerebral blood flow; CMRo 2 = cerebral metabolic rate of oxygen; COVID-19 = coronavirus disease 2019; CPB = cardiopulmonary bypass; dP/dT = change in the pressure over time ratio; HITS = high-intensity transient signal; IT = intratracheal; LE = lower extremity; LV = left ventricular; LVEF = left ventricular ejection fraction; NIRS = near-infrared spectroscopy; pEEG = processed electroencephalography; Pfa = femoral artery pressure; Ppa = pulmonary artery pressure; Pra = radial arterial pressure; Prv = right ventricular pressure; rSo 2 = regional oxygen saturation; RV = right ventricular; SVC = superior vena cava; TCD = transcranial Doppler; UE = upper extremity

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“…Prior studies have not directly investigated the association between intraoperative JVC and delirium following lung transplant; however, multiple studies have suggested the possible association. Dabrowski et al 11 showed that elevated jugular venous bulb pressure during cardiac surgery was associated with increased levels of plasma glial, neuronal, and BBB injury biomarkers. 12 In a separate study, it was demonstrated that the elevation of serum neuronal biomarkers, such as neuron specific enolase and tau protein, was associated with cognitive dysfunction following cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Jugular venous congestion during off‐pump lung transplantation is not associated with an increased risk of postoperative delirium

Mubashir

Wanderer

Lambright

et al. 2022

Clinical Transplantation

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Introduction: Delirium occurs frequently after lung transplantation and is associated with poor clinical outcomes. Significantly prolonged jugular venous congestion (JVC) occurs during off-pump lung transplantation and is thought to impair cerebral perfusion. Our study aimed to test the hypothesis that increased intraoperative JVC is associated with an increased risk of postoperative delirium among lung transplantation recipients. Methods: This is a retrospective observational cohort study. Adult patients who received off-pump lung transplantation at the Vanderbilt University Medical Center between 2006 and 2016 are included. The magnitude of JVC was calculated by the area under the curve (AUC) of the central venous pressure (CVP) above the threshold of 12 mmHg. Postoperative delirium was assessed by Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) criteria during their ICU stay. Multivariate regression analysis was used to determine the association of intraoperative JVC with postoperative delirium, adjusting for baseline demographics, surgical, and intraoperative characteristics.Results: Thirty-two (23.5%) out of 136 patients developed delirium in the ICU. There was no statistical difference in terms of intraoperative JVC between patients with delirium and those without (4058 ± 6650 vs. 3495 ± 10 151 mmHg min; p = .772).Furthermore, during multivariate regression analysis, JVC was not associated with an increased risk of delirium (odds ratio: 1.03 per 100 mmHg min increase in venous congestion; 95% confidence interval: .31, 3.39; p = .96).Conclusions: Delirium occurred frequently after off-pump lung transplantation.Although physiologically plausible, the present study did not find an association between increased JVC during off-pump lung transplantation and an increased risk of postoperative delirium.

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Raised Jugular Venous Pressure Intensifies Release of Brain Injury Biomarkers in Patients Undergoing Cardiac Surgery

Cited by 12 publications

References 36 publications

Idiopathic sudden sensorineural hearing loss and ménière syndrome: The role of cerebral venous drainage

Idiopathic sudden sensorineural hearing loss and ménière syndrome: The role of cerebral venous drainage

Early Detection and Correction of Cerebral Desaturation With Noninvasive Oxy-Hemoglobin, Deoxy-Hemoglobin, and Total Hemoglobin in Cardiac Surgery: A Case Series

Jugular venous congestion during off‐pump lung transplantation is not associated with an increased risk of postoperative delirium

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