| The impact of Trendelenburg position and positive end-expiratory pressure on the internal jugular cross-sectional area. | |
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MedLine Citation:
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PMID: 20484538 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Increasing the cross-sectional area (CSA) of the right internal jugular vein facilitates cannulation and decreases complications. Maneuvers such as the Trendelenburg tilt position and ventilation with a positive end-expiratory pressure (PEEP) may increase the CSA of the right internal jugular vein. We determined the changes in the CSA in response to different maneuvers. METHODS: The CSA (cm(2)) of the right internal jugular vein was assessed in 50 anesthetized adult cardiothoracic surgery patients using 2-dimensional ultrasound. First, the CSA was measured in response to supine position with no PEEP (control condition, S0) and compared with 5 different randomly ordered maneuvers: (1) PEEP ventilation with 5 cm H(2)O (S5), (2) PEEP with 10 cm H(2)O (S10), (3) a 20 degrees Trendelenburg tilt position with a PEEP of 0 cm H(2)O (T0), (4) a 20 degrees Trendelenburg tilt position combined with a PEEP of 5 cm H(2)O (T5), and (5) a 20 degrees Trendelenburg tilt position combined with a PEEP of 10 cm H(2)O (T10). RESULTS: All maneuvers increased the CSA of the right internal jugular vein with respect to the control condition S0 (all P < 0.05). S5 increased the CSA on average by 15.9%, S10 by 22.3%, T0 by 39.4%, T5 by 38.7%, and T10 by 49.7%. CONCLUSION: In a comparison of the effectiveness of applying different PEEP levels and/or the Trendelenburg tilt position on the CSA of the right internal jugular vein, the Trendelenburg tilt position was most effective. |
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Authors:
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Hanke E Marcus; Egfried Bonkat; Oguzhan Dagtekin; Robert Schier; Frank Petzke; Jens Wippermann; Bernd W Böttiger; Peter Teschendorf |
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Publication Detail:
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Type: Comparative Study; Journal Article; Randomized Controlled Trial Date: 2010-05-19 |
Journal Detail:
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Title: Anesthesia and analgesia Volume: 111 ISSN: 1526-7598 ISO Abbreviation: Anesth. Analg. Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-07-28 Completed Date: 2010-08-26 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 1310650 Medline TA: Anesth Analg Country: United States |
Other Details:
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Languages: eng Pagination: 432-6 Citation Subset: AIM; IM |
Affiliation:
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Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany. hanke.marcus@uk-koeln.d |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Catheterization, Central Venous* Coronary Artery Bypass Head-Down Tilt* Heart Valve Prosthesis Implantation Humans Jugular Veins / ultrastructure* Middle Aged Positive-Pressure Respiration* Pulmonary Surgical Procedures Supine Position |
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