Abstract 17313: Bedside Ultrasound for Serial Assessment of Central Venous Pressure in Patients with Volume Overload

Abstract

Background: Using bedside ultrasound, we have previously shown that a greater than 17% increase in internal jugular vein (IJ) cross sectional area (CSA) during Valsalva rules out elevated right atrial pressure (RAP > 12mmHg, NPV 94%). This occurs because venous compliance increases nonlinearly with increasing pressure. Here, we sought to validate this US test in the first longitudinal study of patients undergoing acute volume removal during hemodialysis (HD) as well as patients undergoing diuresis for acute decompensated heart failure (ADHF). Methods: Images of the right IJ were captured using portable bedside US before and during the strain phase of a standardized Valsalva maneuver (Fig 1) on hospitalized patients who were either admitted for ADHF or undergoing HD. For HD patients (n=11), percent change in IJ CSA with Valsalva (ΔCSA) was assessed both before and after HD treatment. For ADHF patients (n=37), ΔCSA was measured both at admission and discharge. Results: For HD patients, analysis of US images detected elevated filling pressures (ΔCSA <17%) in 11 of the patients studied. In these subjects, a mean fluid volume of 1.8L was removed and 10 subjects demonstrated an increased ΔCSA after HD (ΔCSA increase of 45 ± 40%, p17% indicating restoration of normal filling pressures. Of the 37 ADHF patients studied with elevated filling pressures at admission (ΔCSA <17%), 27 demonstrated euvolemia after diuresis (ΔCSA increase of 57 ± 157%, p<0.01) and an average length of stay of 7.8 days. Conclusion: US of the IJ can be used to examine intravascular volume status in response to fluid changes that occur over the course of hours (HD) or days (ADHF). This simple bedside technique could be utilized for monitoring volume changes, both acutely and longer term, to guide volume management and overcome some of the difficulties associated with traditional visual assessment of jugular venous pulsations.