Document Detail

The impact of Trendelenburg position and positive end-expiratory pressure on the internal jugular cross-sectional area.
MedLine Citation:
PMID:  20484538     Owner:  NLM     Status:  MEDLINE    
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.
Hanke E Marcus; Egfried Bonkat; Oguzhan Dagtekin; Robert Schier; Frank Petzke; Jens Wippermann; Bernd W Böttiger; Peter Teschendorf
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2010-05-19
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  111     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-28     Completed Date:  2010-08-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  432-6     Citation Subset:  AIM; IM    
Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany. hanke.marcus@uk-koeln.d
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MeSH Terms
Catheterization, Central Venous*
Coronary Artery Bypass
Head-Down Tilt*
Heart Valve Prosthesis Implantation
Jugular Veins / ultrastructure*
Middle Aged
Positive-Pressure Respiration*
Pulmonary Surgical Procedures
Supine Position

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

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