Jugular Venous Oxygen Saturation (SjvO₂) vs. Cerebral Pulse Oximetry in Traumatic Brain Injury (TBI): A Systematic Review

Abstract

Context: This systematic review evaluates the comparative effectiveness of jugular venous oxygen saturation (SjvO2) and cerebral near-infrared spectroscopy (NIRS) in monitoring cerebral oxygenation in patients with traumatic brain injury (TBI). Objectives: The aim is to assess their technical performance, clinical correlation, and prognostic value. Methods: We conducted a systematic review in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A comprehensive search of PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus (1996 - 2023) identified studies comparing SjvO2 and NIRS, or either modality against the reference standard of brain tissue oxygen (PbtO2) in adult TBI patients. Of 32 studies included for qualitative synthesis, 24 provided comparable data for quantitative summary. Results: The SjvO2 provides a global assessment of cerebral oxygenation but is invasive. It reliably detects global cerebral ischemia (thresholds < 50 - 55%) but may miss regional ischemia and is subject to data quality issues. The NIRS offers continuous, non-invasive regional monitoring of cerebral oxygenation but is primarily limited to the frontal cortex. It effectively identifies focal hypoxia but may miss severe global ischemia and is susceptible to extracranial contamination. Comparative effectiveness: The SjvO2 demonstrates superior detection of global ischemia, while NIRS excels at identifying regional or focal hypoxia. Their correlation is variable and highly dependent on the nature of the injury (diffuse vs. focal). Conclusions: The SjvO2 and NIRS offer complementary strengths in monitoring TBI patients. The SjvO2 remains valuable for detecting global ischemia, whereas NIRS is advantageous for non-invasive, continuous regional monitoring. A combined multimodal monitoring strategy — integrating these tools with PbtO2 where appropriate — appears optimal for comprehensive assessment. The main limitations of this review include significant heterogeneity between studies and the observational nature of most available evidence. Future research must focus on standardizing protocols and validating the impact of such multimodal monitoring on clinical outcomes.