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. 2014 Sep;119(3):619-621.
doi: 10.1213/ANE.0000000000000347.

Positive end-expiratory pressure to increase internal jugular vein size is poorly tolerated in obese anesthetized adults

Laura A Downey  1 , Kevin P Blaine, Jan Sliwa, Alex Macario, John Brock-Utne
Affiliations

Positive end-expiratory pressure to increase internal jugular vein size is poorly tolerated in obese anesthetized adults

Laura A Downey et al. Anesth Analg. 2014 Sep.

Abstract

Background: Central venous cannulation is technically challenging in obese patients. We hypothesized that positive end-expiratory pressure (PEEP) increases the size of the internal jugular vein (IJV) in obese adults.

Methods: The circumference and cross-sectional area of the IJV were measured in obese patients under general anesthesia at PEEP 0, 5, and 10 cm H2O. Results are reported as means ± SE.

Results: PEEP at 10 cm H2O was tolerated by 18 of 24 obese patients. Each 5 cm H2O of PEEP increased the cross-sectional area by 0.16 ± 0.02 cm (P < 0.0001) and the circumference by 0.23 ± 0.03 cm (P < 0.0001).

Conclusions: PEEP modestly increases the size of the IJV in obese adults but was poorly tolerated because of hypotension.

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Comment in

  • Randomization in a Crossover Design Is Not to Be a Minor Issue.
    Apiliogullari S, Onal O. Apiliogullari S, et al. Anesth Analg. 2015 Oct;121(4):1112. doi: 10.1213/ANE.0000000000000833. Anesth Analg. 2015. PMID: 26378710 No abstract available.
  • In Response.
    Downey L, Blaine K, Sliwa J, Macario A, Brock-Utne J. Downey L, et al. Anesth Analg. 2015 Oct;121(4):1113. doi: 10.1213/ANE.0000000000000827. Anesth Analg. 2015. PMID: 26378711 No abstract available.

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