Use of jugular venous blood, compared with mixed venous blood, for measurement of venous oxygenation indices in a porcine model of endotoxic shock.

OBJECTIVE: To evaluate the reliability of oxygen saturation and oxygen content values measured from jugular venous blood in estimating values measured from mixed venous blood during endotoxic shock. ANIMALS: 14 random-bred 10- to 15-kg Yorkshire pigs. PROCEDURE: 60 pairs of heparinized blood samples were simultaneously collected from the pulmonary artery and right jugular vein during an independent study, using a porcine model of endotoxic shock. Endotoxic shock was induced by infusion of Escherichia coli endotoxin. Eighteen of the sample pairs were obtained from pigs prior to infusion of endotoxin or from control pigs. Oxygen saturation and venous oxygen content were measured by direct oximetry. Analysis of bias and precision was used to compare jugular venous blood values with values obtained from mixed venous blood. Samples from endotoxemic pigs were subclassified on the basis of abnormal states of global oxygen imbalance associated with septic shock. RESULTS: Indices of venous oxygenation measured from jugular venous blood were an imprecise method of estimating values measured from mixed venous blood. There was no significant difference in bias between nonendotoxemic and endotoxemic pigs, regardless of abnormal hemodynamic states. CONCLUSION: Jugular venous blood oxygen saturation and oxygen content values should not be used to assess global oxygen transport during endotoxic shock.

Cyclical self-injurious behavior, contingent water mist treatment, and the possibility of rapid-cycling bipolar disorder.

Cyclical self-injurious behavior (SIB) in the form of self-slapping was treated in a 45-year-old, profoundly retarded woman who had a life-long history of SIB. Her SIB alternated between high (mean = 8.54 responses per min; SD = 6.77 and low (mean = 0.05 responses per min; SD = 0.20) frequencies every 8 weeks on average. Instances of self-slapping produced water mist treatment paired with a verbal command, "No hitting". Absence of self-slapping and/or completion of a work task led to a variety of outcomes, including brief back rubs, sips of water, small edibles, and praise. Water mist treatment reduced the frequency of SIB within treatment days during high frequency periods, but produced no reduction across treatment days. Treatment onset was associated with a slight increase in the frequency of SIB during three of the five low frequency periods. However, water mist treatment suppressed SIB completely in sessions during low frequency periods and the suppression continued across treatment days. Water mist treatment produced no discernible changes in the length of the high and low frequency periods of SIB.