Is There an Optimal Positive End-Expiratory Pressure to Measure the Internal Jugular Vein Collapsibility Index? A Pilot Study in Mechanically Ventilated Patients
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Abstract
Background: Hemodynamic monitoring its early stabilization is very important in critically ill patients. Evaluating the Internal jugular vein diameter during respiratory cycles by the means of Point-of care ultrasound provides an important, easily available and precise index for monitoring hemodynamic status; a new method which is called Internal Jugular Vein Collapsibility Index (IJV-CI). Any events that alters intrathoracic volumes and pressures may affect this index. In this study we investigate the effects of various levels of positive end-expiratory pressure on this index.
Methods: Thirty mechanically ventilated patients were studied. We used three different PEEP levels (0, 5 and 10 cmH2o) and point-of-care ultrasound evaluation of IJV (Internal Jugular Vein) diameter to determine the IJV-CI. The analysis were performed using SPSS V.25.0.
Results: Patients were included men (76.6%) and women (33.3%). The mean age of patients was 39.65±3.4 for men and 42.71± 9.34 for women. The IJV-CI were 20.71±11.77 and 24.25±11.46 in PEEP=0 and PEEP=10 cmH20 groups respectively. In 5cmH20-PEEP group median and interquartile range were 16.45(14.8). The IJV-CI in three different PEEP levels were not statistically significantly different.
Conclusion: According to the finding of this study, we found no evidence of an optimal PEEP level to measure The IJV-CI.
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[2] Killu K, Coba V, Huang Y, Andrezejewski T, Dulchavsky S. Internal jugular vein collapsibility index associated with hypovolemia in the intensive care unit patients. Critical Ultrasound Journal. 2010;2(1):13-7.
[3] Marik PE, Cavallazzi R, Vasu T, Hirani A. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009; 37(9):2642-7.
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[7] Jassim HM, Naushad VA, Khatib MY, Chandra P, Abuhmaira MM, Koya SH, et al. IJV collapsibility index vs IVC collapsibility index by point of care ultrasound for estimation of CVP: a comparative study with direct estimation of CVP. Open Access Emerg Med. 2019; 11:65-75.
[8] Kent A, Patil P, Davila V, Bailey JK, Jones C, Evans DC, et al. Sonographic evaluation of intravascular volume status: Can internal jugular or femoral vein collapsibility be used in the absence of IVC visualization? Ann Thorac Med. 2015; 10(1):44-9.
[9] Constant J. Using internal jugular pulsations as a manometer for right atrial pressure measurements. Cardiology. 2000; 93(1-2):26-30.
[10] Thudium M, Klaschik S, Ellerkmann RK, Putensen C, Hilbert T. Is internal jugular vein extensibility associated with indices of fluid responsiveness in ventilated patients? Acta Anaesthesiol Scand. 2016; 60(6):723-33.
[11] Broilo F, Meregalli A, Friedman G. Right internal jugular vein distensibility appears to be a surrogate marker for inferior vena cava vein distensibility for evaluating fluid responsiveness. Rev Bras Ter Intensiva. 2015; 27(3):205-11.
[12] van den Berg PC, Jansen JR, Pinsky MR. Effect of positive pressure on venous return in volume-loaded cardiac surgical patients. J Appl Physiol (1985). 2002; 92(3):1223-31.
[13] Shojaee M, Sabzghabaei A, Alimohammadi H, Derakhshanfar H, Amini A, Esmailzadeh B. Effect of Positive End-Expiratory Pressure on Central Venous Pressure in Patients under Mechanical Ventilation. Emerg (Tehran). 2017;5(1):e1.
[14] Cao F, Chen RL, Liu XF, He R. [Effect of positive end-expiratory pressure on the pressure gradient of venous return in hypovolemic patients under mechanical ventilation]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2009; 21(10):583-6.
[15] Kim N, Shim JK, Choi HG, Kim MK, Kim JY, Kwak YL. Comparison of positive end-expiratory pressure-induced increase in central venous pressure and passive leg raising to predict fluid responsiveness in patients with atrial fibrillation. Br J Anaesth. 2016; 116(3):350-6.
[16] Yang ZL, Zhou JQ, Sun BL, Qian ZX, Zhao H, Liu WD. [The influence of positive end-expiratory pressure on central venous pressure in patients with severe craniocerebral injury]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2012; 24(5):283-5.
[17] Donahue SP, Wood JP, Patel BM, Quinn JV. Correlation of sonographic measurements of the internal jugular vein with central venous pressure. Am J Emerg Med. 2009; 27(7):851-5.
[18] Unluer EE, Kara PH. Ultrasonography of jugular vein as a marker of hypovolemia in healthy volunteers. Am J Emerg Med. 2013; 31(1):173-7.
[19] Bauman Z, Coba V, Gassner M, Amponsah D, Gallien J, Blyden D, et al. Inferior vena cava collapsibility loses correlation with internal jugular vein collapsibility during increased thoracic or intra-abdominal pressure. J Ultrasound. 2015; 18(4):343-8.
[20] Manzano F, Fernández-Mondéjar E, Colmenero M, Poyatos ME, Rivera R, Machado J, et al. Positive-end expiratory pressure reduces incidence of ventilator-associated pneumonia in nonhypoxemic patients. Crit Care Med. 2008; 36(8):2225-31.
[21] Pinsky MR. Instantaneous venous return curves in an intact canine preparation. J Appl Physiol Respir Environ Exerc Physiol. 1984; 56(3):765-71.
[22] Malhotra A. Low-tidal-volume ventilation in the acute respiratory distress syndrome. N Engl J Med. 2007; 357(11):1113-20.
[23] García-Prieto E, Amado-Rodríguez L, Albaiceta GM. [Monitorization of respiratory mechanics in the ventilated patient]. Med Intensiva. 2014; 38(1):49-55.
[2] Killu K, Coba V, Huang Y, Andrezejewski T, Dulchavsky S. Internal jugular vein collapsibility index associated with hypovolemia in the intensive care unit patients. Critical Ultrasound Journal. 2010;2(1):13-7.
[3] Marik PE, Cavallazzi R, Vasu T, Hirani A. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009; 37(9):2642-7.
[4] Keller AS, Melamed R, Malinchoc M, John R, Tierney DM, Gajic O. Diagnostic accuracy of a simple ultrasound measurement to estimate central venous pressure in spontaneously breathing, critically ill patients. J Hosp Med. 2009; 4(6):350-5.
[5] Nakamura K, Qian K, Ando T, Inokuchi R, Doi K, Kobayashi E, et al. Cardiac Variation of Internal Jugular Vein for the Evaluation of Hemodynamics. Ultrasound Med Biol. 2016;42(8):1764-70.
[6] Haliloğlu M, Bilgili B, Kararmaz A, Cinel İ. The value of internal jugular vein collapsibility index in sepsis. Ulus Travma Acil Cerrahi Derg. 2017; 23(4):294-300.
[7] Jassim HM, Naushad VA, Khatib MY, Chandra P, Abuhmaira MM, Koya SH, et al. IJV collapsibility index vs IVC collapsibility index by point of care ultrasound for estimation of CVP: a comparative study with direct estimation of CVP. Open Access Emerg Med. 2019; 11:65-75.
[8] Kent A, Patil P, Davila V, Bailey JK, Jones C, Evans DC, et al. Sonographic evaluation of intravascular volume status: Can internal jugular or femoral vein collapsibility be used in the absence of IVC visualization? Ann Thorac Med. 2015; 10(1):44-9.
[9] Constant J. Using internal jugular pulsations as a manometer for right atrial pressure measurements. Cardiology. 2000; 93(1-2):26-30.
[10] Thudium M, Klaschik S, Ellerkmann RK, Putensen C, Hilbert T. Is internal jugular vein extensibility associated with indices of fluid responsiveness in ventilated patients? Acta Anaesthesiol Scand. 2016; 60(6):723-33.
[11] Broilo F, Meregalli A, Friedman G. Right internal jugular vein distensibility appears to be a surrogate marker for inferior vena cava vein distensibility for evaluating fluid responsiveness. Rev Bras Ter Intensiva. 2015; 27(3):205-11.
[12] van den Berg PC, Jansen JR, Pinsky MR. Effect of positive pressure on venous return in volume-loaded cardiac surgical patients. J Appl Physiol (1985). 2002; 92(3):1223-31.
[13] Shojaee M, Sabzghabaei A, Alimohammadi H, Derakhshanfar H, Amini A, Esmailzadeh B. Effect of Positive End-Expiratory Pressure on Central Venous Pressure in Patients under Mechanical Ventilation. Emerg (Tehran). 2017;5(1):e1.
[14] Cao F, Chen RL, Liu XF, He R. [Effect of positive end-expiratory pressure on the pressure gradient of venous return in hypovolemic patients under mechanical ventilation]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2009; 21(10):583-6.
[15] Kim N, Shim JK, Choi HG, Kim MK, Kim JY, Kwak YL. Comparison of positive end-expiratory pressure-induced increase in central venous pressure and passive leg raising to predict fluid responsiveness in patients with atrial fibrillation. Br J Anaesth. 2016; 116(3):350-6.
[16] Yang ZL, Zhou JQ, Sun BL, Qian ZX, Zhao H, Liu WD. [The influence of positive end-expiratory pressure on central venous pressure in patients with severe craniocerebral injury]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2012; 24(5):283-5.
[17] Donahue SP, Wood JP, Patel BM, Quinn JV. Correlation of sonographic measurements of the internal jugular vein with central venous pressure. Am J Emerg Med. 2009; 27(7):851-5.
[18] Unluer EE, Kara PH. Ultrasonography of jugular vein as a marker of hypovolemia in healthy volunteers. Am J Emerg Med. 2013; 31(1):173-7.
[19] Bauman Z, Coba V, Gassner M, Amponsah D, Gallien J, Blyden D, et al. Inferior vena cava collapsibility loses correlation with internal jugular vein collapsibility during increased thoracic or intra-abdominal pressure. J Ultrasound. 2015; 18(4):343-8.
[20] Manzano F, Fernández-Mondéjar E, Colmenero M, Poyatos ME, Rivera R, Machado J, et al. Positive-end expiratory pressure reduces incidence of ventilator-associated pneumonia in nonhypoxemic patients. Crit Care Med. 2008; 36(8):2225-31.
[21] Pinsky MR. Instantaneous venous return curves in an intact canine preparation. J Appl Physiol Respir Environ Exerc Physiol. 1984; 56(3):765-71.
[22] Malhotra A. Low-tidal-volume ventilation in the acute respiratory distress syndrome. N Engl J Med. 2007; 357(11):1113-20.
[23] García-Prieto E, Amado-Rodríguez L, Albaiceta GM. [Monitorization of respiratory mechanics in the ventilated patient]. Med Intensiva. 2014; 38(1):49-55.
| Files | ||
| Issue | Vol 7 No 4 (2021): Autumn |
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| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v7i4.7628 | |
| Keywords | ||
| Internal jugular vein collapsibility index Positive end-expiratory pressure Hemodynamic monitoring Intensive Care Units (ICU) patients | ||
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How to Cite
1.
Zeraatchi A, Naghibi T, Kafili H, Abdollahi Sabet S. Is There an Optimal Positive End-Expiratory Pressure to Measure the Internal Jugular Vein Collapsibility Index? A Pilot Study in Mechanically Ventilated Patients. Arch Anesth & Crit Care. 2021;7(4):223-226.
