Correlation of Internal Jugular Vein and Inferior Vena Cava Collapsibility Index with Direct Central Venous Pressure Measurement in Critically-ill Patients: An Observational Study
Anuj Kumar, Alok K Bharti, Mumtaz Hussain, Arvind Kumar
Keywords :
Central venous pressure, Critically ill patients, Inferior vena cava collapsibility index, Internal jugular vein, Volume status
Citation Information :
Kumar A, Bharti AK, Hussain M, Kumar A. Correlation of Internal Jugular Vein and Inferior Vena Cava Collapsibility Index with Direct Central Venous Pressure Measurement in Critically-ill Patients: An Observational Study. Indian J Crit Care Med 2024; 28 (6):595-600.
Background and aims: Prompt assessments and quick replacement of intravascular fluid are critical steps to resuscitate hypovolemic patients. Intravascular volume assessment by direct central venous pressure (CVP) measurement is an invasive, time-consuming, and labor-intensive procedure. Nowadays, bedside ultrasound-guided volume assessment of the internal jugular vein (IJV) or inferior vena cava (IVC) is commonly employed as a proxy for direct CVP.
Therefore, we examined the strength of association between CVP and collapsibility index (CI) of the IJV and IVC for evaluating the volume status of critically ill patients.
Methods: Bedside USG-guided A–P diameter and cross-sectional area of the right IJV and IVC were measured, and their corresponding collapsibility indices were deduced. The results of the IJV and IVC indices were correlated with CVP.
Results: About 60 out of 70 enrolled patients were analyzed. The baseline clinical parameters of patients are shown in Table 1. For CSA and AP diameter, the correlations between CVP and IJV-CI at 0° were r = –0.107 (p = 0.001) and r = –0.092 (p = 0.001). Correlations between CVP and IJV-CI at 30° for CSA and diameter, however, were (r = –0.109, p = 0.001) and (r = –0.117, p = 0.001), respectively. Table 2 depicts the correlation between CVP and IVC-CI r = –0.503, p = 0.001 for CSA and r = –0.452, p = 0.001 for diameter.
Conclusion: The IVC and IJV collapsibility indices can be used in place of invasive CVP monitoring to assess fluid status in critically ill patients.
Nguyen HB, Jaehne AK, Jayaprakash N, Semler MW, Hegab S, Yataco AC, et al. Early goal-directed therapy in severe sepsis and septic shock: Insights and comparisons to ProCESS, ProMISe, and ARISE. Crit Care 2016;20(1):160. DOI: 10.1186/s13054-016-1288-3.
Rossaint R, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, et al. Task force for advanced bleeding care in trauma. Management of bleeding following major trauma: An updated European guideline. Crit Care 2010;14(2):R52. DOI: 10.1186/cc8943.
Saugel B, Ringmaier S, Holzapfel K, Schuster T, Phillip V, Schmid RM, et al. Physical examination, central venous pressure, and chest radiography for the prediction of transpulmonary thermodilution-derived hemodynamic parameters in critically ill patients: A prospective trial. J Crit Care 2011;26(4):402–410. DOI: 10.1016/j.jcrc.2010.11.001.
Patil P, Kelly N, Papadimos TJ, Bahner D, Stawicki S. Correlations between venous collapsibility and common hemodynamic and ventilatory parameters. International Journal of Academic Medicine 2016;2(Suppl 1):S25–S33. DOI: 10.4103/2455-5568.188738.
Nagdev AD, Merchant RC, Tirado-Gonzalez A, Sisson CA, Murphy MC. Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure. Ann Emerg Med 2010;55(3):290–295. DOI: 10.1016/j.annemergmed.2009.04.021.
Schefold JC, Storm C, Bercker S, Pschowski R, Oppert M, Krüger A, et al. Inferior vena cava diameter correlates with invasive hemodynamic measures in mechanically ventilated intensive care unit patients with sepsis. J Emerg Med 2010;38(5):632–637. DOI: 10.1016/j.jemermed.2007.11.027.
Wachsberg RH, Sebastiano LL, Levine CD. Narrowing of the upper abdominal inferior vena cava in patients with elevated intraabdominal pressure. Abdom Imaging 1998;23(1):99–102. DOI: 10.1007/s002619900295.
Rein AJ, Lewis N, Forst L, Gotsman MS, Lewis BS. Echocardiography of the inferior vena cava in healthy subjects and in patients with cardiac disease. Isr J Med Sci 1982;18(5):581–585. PMID: 7096041.
Brennan JM, Blair JE, Goonewardena S, Ronan A, Shah D, Vasaiwala S, et al. Reappraisal of the use of inferior vena cava for estimating right atrial pressure. J Am Soc Echocardiogr 2007;20(7):857–861. DOI: 10.1016/j.echo.2007.01.005.
Killu K, Coba V, Huang Y, Andrezejewski T, Dulchavsky S. Internal jugular vein collapsibility index associated with hypovolemia in the intensive care unit patients. Crit Ultrasound J 2010;2:13–17. DOI: 10.1007/s13089-010-0034-3.
Akilli NB, Cander B, Dundar ZD, Koylu R. A new parameter for the diagnosis of hemorrhagic shock: Jugular index. J Crit Care 2012;27(5):530.e13–e18. DOI: 10.1016/j.jcrc.2012.01.011.
Jassim HM, Naushad VA, Khatib MY, Chandra P, Abuhmaira MM, Koya SH, et al. IJV collapsibility index vs IVC collapsibility index by point of care ultrasound for estimation of CVP: A comparative study with direct estimation of CVP. Open Access Emerg Med 2019;11:65–75. DOI: 10.2147/OAEM.S176175.
Ciozda W, Kedan I, Kehl DW, Zimmer R, Khandwalla R, Kimchi A. The efficacy of sonographic measurement of inferior vena cava diameter as an estimate of central venous pressure. Cardiovasc Ultrasound 2016;14(1):33. DOI: 10.1186/s12947-016-0076-1.
AlaviMoghaddam M, Kabir A, Shojaee M, Manouchehrifar M, Moghimi M. Ultrasonography of inferior vena cava to determine central venous pressure: A metaanalysis and metaregression. Acta Radiol 2017;58(5):537541. DOI: 10.1177/0284185116663045.
Donahue SP, Wood JP, Patel BM, Quinn JV. Correlation of sonographic measurements of the internal jugular vein with central venous pressure. Am J Emerg Med 2009;27(7):851–855. DOI: 10.1016/j.ajem.2008.06.005.
Avcil M, Kapci M, Dagli B, Omurlu IK, Ozluer E, Karaman K, et al. Comparision of ultrasound-based methods of jugular vein and inferior vena cava for estimating central venous pressure. Int J Clin Exp Med 2015;8(7):10586–10594. PMID: 26379848.