The sensitivity and specificity of ultrasound estimation of central venous pressure using the internal jugular vein

Abstract Purpose The fluid volume status of a patient is difficult to assess clinically. The aim of this study was to compare the ultrasound estimation of the height of the right internal jugular vein (CVPIJV ) with direct estimation of central venous pressure (CVP) (CVPCVC ). Materials and Methods...

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Bibliographic Details
Published in:Journal of critical care 2012-06, Vol.27 (3), p.315.e7-315.e11
Main Authors: Siva, Brian, MBBS, Hunt, Austin, MBChB, MRCP, Boudville, Neil, MBBS, FRACP, MMedSci
Format: Article
Language:English
Subjects:
Accuracy
Blood Pressure Determination - methods
Catheterization, Central Venous
Central Venous Pressure
Classification
Clinical medicine
Confidence intervals
Critical Care
Diagnostic tests
Female
Heart failure
Humans
Hypovolemia - diagnosis
Intensive Care Units
Jugular vein
Jugular Veins - diagnostic imaging
Male
Middle Aged
Sensitivity and Specificity
Ultrasonography
Veins & arteries
Ventilation
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Summary:Abstract Purpose The fluid volume status of a patient is difficult to assess clinically. The aim of this study was to compare the ultrasound estimation of the height of the right internal jugular vein (CVPIJV ) with direct estimation of central venous pressure (CVP) (CVPCVC ). Materials and Methods A portable ultrasound machine defined the “top” of the right internal jugular vein in 44 patients from a single tertiary hospital. The vertical height from this point to the sternal angle was used to estimate CVPIJV . A central venous catheter was then inserted and direct measurement of CVP was made with a pressure transducer. A normal CVP was defined as 3 to 6 mm Hg. Results For overloaded patients, CVPIJV correlated well with CVPCVC , P = .004, sensitivity of 64.3%, specificity of 81.3%, and positive predictive value of 85.7%. The area under the curve for the receiver operating characteristic curve was 0.73 (95% confidence interval, 0.59-0.86). For undervolumed patients, the correlation remained statistically significant, P < .001, sensitivity of 88.9%, specificity of 77.1%, and negative predictive value of 96.4%. The area under the curve was 0.83 (95% confidence interval, 0.70-0.96). Conclusion Ultrasound estimation of CVP using a portable ultrasound machine and the internal jugular vein is simple, noninvasive, and accurate.
ISSN:0883-9441
1557-8615
DOI:10.1016/j.jcrc.2011.09.008