Internal jugular distensibility index as a predictor of fluid responsiveness in adult patients undergoing elective surgery - A prospective accuracy study

Abstract

Background and aims: Assessing the intravascular volume is necessary in patients undergoing surgery, but predicting how the body will respond to fluid can be challenging. Evaluation of the internal jugular vein distensibility index (IJV-DI) is an alternative method to determine intravascular volume status. This study aims to determine the suitability of measuring stroke volume by using IJV-DI measurement compared with transthoracic echocardiography in assessing the fluid responsiveness in elective surgery patients.

Methods: This prospective study involved 79 subjects undergoing elective surgery under general anaesthesia. Following anaesthesia induction, IJV-DI and stroke volume measurements were performed before and after fluid administration. Subjects experiencing an increase in stroke volume of more than 10% were categorised as responders. The primary outcome was the suitability of IJV-DI in determining fluid responsiveness compared to transthoracic echocardiography in elective surgery patients. The data were then analysed to assess its diagnostic value using the receiver operator characteristic (ROC) curve, the appropriate cut-off point using the Youden index, and the correlation using Spearman's correlation test.

Results: A total of 45 subjects were responders. Our analysis revealed an area under the curve (AUC) value of 0.871 (95% CI: 0.790, 0.951). The optimal cut-off value was found at an internal jugular vein distensibility index of >12.62% with a sensitivity of 84.4% and a specificity of 79.4%. A moderate positive correlation existed between the index and stroke volume increase (r = 0.535, P < 0.001).

Conclusion: IJV-DI assessment is compatible with transthoracic echocardiography stroke volume measurement for evaluating elective surgery patients' fluid response.

Keywords: Echocardiography; fluid therapy; general surgery; internal jugular vein distensibility index; jugular veins; stroke volume; ultrasonography.

Figure 1

Measurement of IJV-DI by using Ultrasound and SV by using Echocardiography. (a) Transducer position to measure IJV. (b) Visualisation of the IJV. (c) Transducer position in the parasternal long-axis view. (d) Transducer position in 5-chamber apical view. (e) Calculation of SV. IJV = Internal Jugular Vein, DI = Distensibility Index, SV = Stroke Volume

Figure 2

Research Flow. IV = Intravenous, TV = Tidal Volume, BW = Body Weight, FiO2 = Fraction of Inspired Oxygen, PEEP = Positive End-Expiratory Pressure, RR = Respiratory Rate, SV = Stroke Volume

Figure 3

ROC curve and the intersection point of the sensitivity-specificity for distensibility index in response to fluid administration. (a) The AUC value obtained from ROC curve analysis was 0.871 (95% CI: 0.790, 0.951). (b) The distensibility index value of >12.62% indicated a sensitivity of 84.4% and a specificity of 79.4%, with an intersection point (Youden index) of 0.638. ROC = receiver operating characteristic, AUC = area under the curve.