Diagnostic accuracy of a simple ultrasound measurement to estimate central venous pressure in spontaneously breathing, critically ill patients

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 no...

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Bibliographic Details
Published in:Journal of hospital medicine 2009-07, Vol.4 (6), p.350-355
Main Authors: Keller, A. Scott, Melamed, Roman, Malinchoc, Michael, John, Reverly, Tierney, David M., Gajic, Ognjen
Format: Article
Language:English
Subjects:
Adult
central venous pressure
Central Venous Pressure - physiology
Critical Illness - therapy
Diagnostic Equipment - standards
Diagnostic Equipment - statistics & numerical data
early goal-directed therapy
Female
Humans
internal jugular vein
Jugular Veins - diagnostic imaging
Male
Middle Aged
Prospective Studies
Respiration
sensitivity
septic shock
severe sepsis
specificity
Ultrasonography
ultrasound imaging
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Summary: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
ISSN:1553-5592
1553-5606
DOI:10.1002/jhm.503