Internal jugular vein variability predicts fluid responsiveness in cardiac surgical patients with mechanical ventilation

Guo-Guang Ma, Guang-Wei Hao, Xiao-Mei Yang, Du-Ming Zhu, Lan Liu, Hua Liu, Guo-Wei Tu, Zhe Luo, Guo-Guang Ma, Guang-Wei Hao, Xiao-Mei Yang, Du-Ming Zhu, Lan Liu, Hua Liu, Guo-Wei Tu, Zhe Luo

Abstract

Background: To evaluate the efficacy of using internal jugular vein variability (IJVV) as an index of fluid responsiveness in mechanically ventilated patients after cardiac surgery.

Methods: Seventy patients were assessed after cardiac surgery. Hemodynamic data coupled with ultrasound evaluation of IJVV and inferior vena cava variability (IVCV) were collected and calculated at baseline, after a passive leg raising (PLR) test and after a 500-ml fluid challenge. Patients were divided into volume responders (increase in stroke volume ≥ 15%) and non-responders (increase in stroke volume < 15%). We compared the differences in measured variables between responders and non-responders and tested the ability of the indices to predict fluid responsiveness.

Results: Thirty-five (50%) patients were fluid responders. Responders presented higher IJVV, IVCV and stroke volume variation (SVV) compared with non-responders at baseline (P < 0.05). The relationship between IJVV and SVV was moderately correlated (r = 0.51, P < 0.01). The areas under the receiver operating characteristic (ROC) curves for predicting fluid responsiveness were 0.88 (CI 0.78-0.94) for IJVV compared with 0.83 (CI 0.72-0.91), 0.97 (CI 0.89-0.99), 0.91 (CI 0.82-0.97) for IVCV, SVV, and the increase in stroke volume in response to a PLR test, respectively.

Conclusions: Ultrasound-derived IJVV is an accurate, easily acquired noninvasive parameter of fluid responsiveness in mechanically ventilated postoperative cardiac surgery patients, with a performance similar to that of IVCV.

Keywords: Cardiac surgery; Fluid responsiveness; Inferior vena cava; Internal jugular veins; Stroke volume variation.

Figures

Fig. 1
Fig. 1
Ultrasound probe position for IJV detection at the cricoid cartilage level (a). The patient is in the supine position at 30°. M-mode assessment of the antero-posterior diameter of the IJV in a responsive patient (b, a high variability of IJV diameter is seen) and in a non-responsive patient (c, lack of variation of the IJV diameter is seen) while on mechanical ventilation
Fig. 2
Fig. 2
Pearson correlation analysis. (a, association between IJVV and SVV; b, association between IVCV and SVV)
Fig. 3
Fig. 3
Comparison of the areas under the ROC curves for the indicators used for predicting fluid responsiveness (a, dynamic indicators; and b, static indicators)

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