Abstract
BackgroundTo evaluate the efficacy of using internal jugular vein variability (IJVV) as an index of fluid responsiveness in mechanically ventilated patients after cardiac surgery.MethodsSeventy 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.ResultsThirty-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.ConclusionsUltrasound-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.
Highlights
To evaluate the efficacy of using internal jugular vein variability (IJVV) as an index of fluid responsive‐ ness in mechanically ventilated patients after cardiac surgery
The exclusion criteria included age < 18 years; evidence of cardiac arrhythmia; evidence of jugular vein thrombosis; bilaterally inserted venous catheters; echocardiographic examination that showed the existence of severe tricuspid or mitral regurgitation or right heart dysfunction; a history of radiotherapy or surgery of the neck region or back; a contraindication to the passive leg raising (PLR) test; and the inability to obtain interpretable ultrasound images due to a difficult acoustic window
Five patients were excluded because visualization of the inferior vena cava (IVC) via ultrasound was technically difficult
Summary
To evaluate the efficacy of using internal jugular vein variability (IJVV) as an index of fluid responsive‐ ness in mechanically ventilated patients after cardiac surgery. Fluid management is one of the most important treatments for stabilizing hemodynamics in patients after cardiac surgery. Based on the influence of cycling intra-thoracic pressure on arterial pulse pressure or stroke volume, dynamic indicators such as arterial pulse pressure variation (PPV) or stroke volume variation (SVV) have been widely used as reliable predictors of fluid responsiveness [6,7,8]. These dynamic parameters have several limitations and can only be used under strict conditions
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