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Jugular bulb oximetry is the first available continuous monitoring method estimating the adequacy of cerebral perfusion. Despite its major technical as well as methodological shortcomings the information on the oxygen supply to demand balance of the brain seems most valuable. Especially the deleterious consequences of systemic variations (mainly concerning arterial blood pressure and CO2-tension) on the diseased brain are revealed by jugular bulb saturation values. The prevention and/or the early detection of these systemic secondary insults could have important implications as to final neurological outcome. Jugular bulb oximetry could also guide specific intracranial antihypertensive treatment, as it may reveal the pathophysiological mechanisms behind intracranial hypertension with regard to the status of cerebral perfusion (cerebral hyperemia or cerebral hypoperfusion). These insights might increase the efficacy of all treatments available for intracranial hypertension.
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