Evaluation of Intravascular Volume Using the Internal Jugular Vein Cardiac Collapse Index in the Emergency Department: A Preliminary Prospective Observational Study.

Abstract

A non-invasive method for assessment of intravascular volume for optimal fluid administration is needed. We here conducted a preliminary study to confirm whether cardiac variation in the internal jugular vein (IJV), evaluated by ultrasound, predicts fluid responsiveness in patients in the emergency department. Patients who presented to the emergency department between August 2019 and March 2020 and required infusions were enrolled. We recorded a short-axis video of the IJV, respiratory variability in the inferior vena cava and stroke volume variations using the ClearSight System (Edwards Lifesciences, Irvine, CA, USA) before infusion of 500 mL of crystalloid fluid. Cardiac variations in the cross-sectional area of the IJV were measured by speckle tracking. Among the 148 patients enrolled, 105 were included in the final analysis. Fluid responsiveness did not correlate with the cardiac collapse index (13.6% vs. 16.8%, p=0.24), but correlated with stroke volume variations (12.5% vs. 15.6%, p=0.026). Although it is a simple correction, the cardiac collapse index correlated with stroke volume corrected by age (r=0.25, p=0.01), body surface area (r=0.33, p=0.002) and both (r=0.35, p=0.001). Cardiac variations in the IJV did not predict fluid responsiveness in the emergency department, but may reflect stroke volume.