Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Jul-Sep;27(3):205-11.
doi: 10.5935/0103-507X.20150042.

Right internal jugular vein distensibility appears to be a surrogate marker for inferior vena cava vein distensibility for evaluating fluid responsiveness

[Article in English, Portuguese]
Fabiano Broilo  1 , Andre Meregalli  1 , Gilberto Friedman  2
Affiliations

Right internal jugular vein distensibility appears to be a surrogate marker for inferior vena cava vein distensibility for evaluating fluid responsiveness

[Article in English, Portuguese]
Fabiano Broilo et al. Rev Bras Ter Intensiva. 2015 Jul-Sep.

Abstract
in English, Portuguese

Objective: To investigate whether the respiratory variation of the inferior vena cava diameter (∆DIVC) and right internal jugular vein diameter (∆DRIJ) are correlated in mechanically ventilated patients.

Methods: This study was a prospective clinical analysis in an intensive care unit at a university hospital. Thirty-nine mechanically ventilated patients with hemodynamic instability were included. ∆DIVC and ∆DRIJ were assessed by echography. Vein distensibility was calculated as the ratio of (A) Dmax--Dmin/Dmin and (B) Dmax--Dmin/ mean of Dmax--Dmin and expressed as a percentage.

Results: ∆DIVC and ∆DRIJ were correlated by both methods: (A) r = 0.34, p = 0.04 and (B) r = 0.51, p = 0.001. Using 18% for ∆DIVC, indicating fluid responsiveness by method (A), 16 patients were responders and 35 measurements showed agreement (weighted Kappa = 0.80). The area under the ROC curve was 0.951 (95%CI 0.830 - 0.993; cutoff = 18.92). Using 12% for ∆DIVC, indicating fluid responsiveness by method (B), 14 patients were responders and 32 measurements showed agreement (weighted Kappa = 0.65). The area under the ROC curve was 0.903 (95%CI 0.765 - 0.973; cut-off value = 11.86).

Conclusion: The respiratory variation of the inferior vena cava and the right internal jugular veins are correlated and showed significant agreement. Evaluation of right internal jugular vein distensibility appears to be a surrogate marker for inferior vena cava vein distensibility for evaluating fluid responsiveness.

Objetivo: Investigar se a variação respiratória no diâmetro da veia cava inferior (ΔDVCI) e no diâmetro da veia jugular interna direita (ΔDVJID) se correlacionam em pacientes submetidos à ventilação mecânica.

Métodos: Estudo clínico prospectivo realizado em uma unidade de terapia intensiva de um hospital universitário. Foram incluídos 39 pacientes mecanicamente ventilados e com instabilidade hemodinâmica. Os valores da variação do diâmetro da veia cava inferior e da variação do diâmetro da veia jugular interna direita foram avaliados por meio de ecografia. A distensibilidade da veia foi calculada como a razão de (A) Dmin - Dmax/Dmin e (B) Dmax - Dmin/média de Dmax - Dmin, e expressa como porcentagem.

Resultados: Com ambos os métodos, observou-se correlação entre a variação do diâmetro da veia cava inferior e a variação do diâmetro da veia jugular interna direita: (A) r = 0,34, p = 0,04 e (B) r = 0,51, p = 0,001. Utilizando o ponto de corte de 18% para indicar responsividade a fluidos na variação do diâmetro da veia cava inferior, pelo o método (A), 16 pacientes foram considerados responsivos e 35 medições mostraram concordância (Kappa ponderado = 0,80). A área sob a curva ROC foi de 0,951 (IC95% 0,830 - 0,993; valor de corte = 18,92). Usando 12% como ponto de corte para a variação do diâmetro da veia cava inferior para indicar capacidade de resposta a fluidos, pelo método (B), 14 pacientes foram responsivos e 32 medições mostraram concordância (Kappa ponderado = 0,65). A área sob a curva ROC foi de 0,903 (IC95% 0,765 - 0,973; valor de corte = 11,86).

Conclusão: As variações respiratórias nas dimensões da veia cava inferior e da veia jugular interna direita se correlacionaram e mostraram concordância significativa. Avaliação da distensibilidade da veia jugular interna direita parece ser uma alternativa à distensibilidade da veia cava inferior para avaliar a responsividade a fluidos.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: None.

Figures

Figure 1
Figure 1
Distensibility of the inferior vena cava and of the right internal jugular vein are strongly correlated by method 1 (fluid responsiveness cut-off value: 18%) and method 2 (fluid responsiveness cut-off value: 12%). The empty points represent the points disagreeing. Pearson correlation test. ∆DIVC - distensibility of inferior vena cava; ∆DRIJV - distensibility right internal jugular vein.
Figure 2
Figure 2
Pearson correlation after logarithmic transformation of the distensibility of the inferior vena cava and of the right internal jugular vein. ∆DIVC - distensibility of inferior vena cava; ∆DRIJV - distensibility right internal jugular vein.
Figure 3
Figure 3
Receiver operating characteristic curve analysis of the right internal jugular vein distensibility index in predicting fluid responsiveness based on inferior vena cava distensibility values of 18% by method A and 12% by method B. The area under the ROC curve was 0.951 (95%CI 0.830 - 0.993) and 0.903 (95%CI 0.765 - 0.973), respectively. ∆DRIJV - distensibility right internal jugular vein; ∆DIVC - distensibility of inferior vena cava.
See this image and copyright information in PMC

Comment in

References

    1. Weil MH, Nishjima H. Cardiac output in bacterial shock. Am J Med. 1978;64(6):920–922. - PubMed
    1. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M, Early Goal-Directed Therapy Collaborative Group Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368–1377. - PubMed
    1. De Backer D, Biston P, Devriendt J, Madl C, Chochrad D, Aldecoa C, Brasseur A, Defrance P, Gottignies P, Vincent JL, SOAP II Investigators Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010;362(9):779–789. - PubMed
    1. Murakawa K, Kobayashi A. Effects of vasopressors on renal tissue gas tensions during hemorrhagic shock in dogs. Crit Care Med. 1988;16(8):789–792. - PubMed
    1. Pinsky MR, Teboul JL. Assessment of indices of preload and volume responsiveness. Curr Opin Crit Care. 2005;11(3):235–239. - PubMed