Document Detail

Diagnostic accuracy of a simple ultrasound measurement to estimate central venous pressure in spontaneously breathing, critically ill patients.
MedLine Citation:
PMID:  19670356     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Early goal-directed therapy for severe sepsis or septic shock improves outcomes but requires placement of a central venous catheter to measure central venous pressure (CVP), which may delay timely resuscitation and cause catheter-related complications. In addition, nonintensivists may not start early aggressive fluid resuscitation because of difficulty estimating CVP and concerns for inadvertent volume overload. OBJECTIVE: To determine if the CVP target of 8 to 12 mm Hg can be accurately assessed using noninvasive ultrasound to measure the internal jugular vein aspect ratio (height/width). DESIGN: Prospective observational study. SETTING: Two academic medical centers. PARTICIPANTS: Nineteen euvolemic volunteers and a convenience sample of 44 spontaneously breathing, critically ill patients. MEASUREMENTS: Ultrasound imaging of internal jugular vein aspect ratio; invasive CVP measurement in critically ill patients. RESULTS: For the volunteers, mean (standard deviation [SD]) aspect ratio of both the right and left internal jugular vein was 0.82 (0.07). Bland-Altman analysis indicated moderate intraobserver and interobserver agreement. Aspect ratio was similar for right and left sides and between men and women. In the critically ill patients, ultrasound accurately estimated a CVP of 8 mm Hg; area under the receiver operating characteristics curve was 0.84. For an invasively measured CVP of <8 mm Hg, the likelihood ratio for a positive ultrasound test (aspect ratio <0.83) was 3.5 and for a negative test (aspect ratio > or =0.83) was 0.30. CONCLUSIONS: In this exploratory study, noninvasive ultrasound imaging of internal jugular vein aspect ratio accurately estimated a CVP of 8 mm Hg in spontaneously breathing, critically ill patients.
A Scott Keller; Roman Melamed; Michael Malinchoc; Reverly John; David M Tierney; Ognjen Gajic
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of hospital medicine : an official publication of the Society of Hospital Medicine     Volume:  4     ISSN:  1553-5606     ISO Abbreviation:  J Hosp Med     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-08-17     Completed Date:  2010-04-30     Revised Date:  2010-06-30    
Medline Journal Info:
Nlm Unique ID:  101271025     Medline TA:  J Hosp Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  350-5     Citation Subset:  IM    
Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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MeSH Terms
Central Venous Pressure / physiology*
Critical Illness* / therapy
Diagnostic Equipment / standards,  statistics & numerical data
Jugular Veins / ultrasonography*
Middle Aged
Prospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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