| Diagnostic accuracy of a simple ultrasound measurement to estimate central venous pressure in spontaneously breathing, critically ill patients. | |
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MedLine Citation:
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PMID: 19670356 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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A Scott Keller; Roman Melamed; Michael Malinchoc; Reverly John; David M Tierney; Ognjen Gajic |
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Publication Detail:
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Type: Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't |
Journal Detail:
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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:
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Created Date: 2009-08-17 Completed Date: 2010-04-30 Revised Date: 2010-06-30 |
Medline Journal Info:
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Nlm Unique ID: 101271025 Medline TA: J Hosp Med Country: United States |
Other Details:
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Languages: eng Pagination: 350-5 Citation Subset: IM |
Affiliation:
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Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. keller.scott@mayo.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Central Venous Pressure / physiology* Critical Illness* / therapy Diagnostic Equipment / standards, statistics & numerical data Female Humans Jugular Veins / ultrasonography* Male Middle Aged Prospective Studies Respiration* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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