Abstract
ObjectiveThe objective of this study is to find a correlation between internal jugular vein (IJV) and common carotid artery (CCA) diameter ratio and central venous pressure (CVP) measurement and find a cut-off value for the IJV/CCA ratio to predict low CVP i.e. < 10 cm H20, for estimating the volume status in critically ill patients.MethodsThis prospective cross-sectional study was conducted at the critical care department of Shifa International Hospital, Islamabad, from July to December 2017. A sample of 49 patients ≥ 18 years with intrathoracic central venous catheters (CVCs) who underwent bedside sonographic assessments of IJV and CCA diameter were included in this study using convenient sampling. The IJV/CCA diameter ratio was calculated and correlated with CVP and the predictive value of the IJV/CCA diameter ratio to predict CVP < 10 cm H2O was explored by calculating the area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, and positive and negative predictive values.ResultsA total of 49 patients, 30 males (61.2%) and 19 females (38.8%) with a mean age of 56.00±16.11 years were included in the study. The mean CVP was 8.98±2.37cm H2O in ventilated (51%) and 10.7± 6.01 cm H2O in non-ventilated (49%) patients. The mean IJV/CCA diameter ratio was 1.60±0.55 at expiration and 1.41±0.56 at inspiration. There was a significant correlation between the IJV/CCA diameter ratio and CVP at expiration (r=0.401, p=0.004). The correlation between IJV/CCA and CVP was significant in non-ventilated patients at expiration (r=0.439, p=0.032). The area under the ROC curve for the IJV/CCA diameter ratio for predicting CVP < 10 cm H2O was 0.684 (p=0.028). The predictive value of the IJV/CCA diameter ratio for CVP < 10 cm H20 at the cutoff value of < 2 was insignificant. A new cut-off < 1.75 was taken for the IJV/CCA diameter ratio from the coordinates of the ROC curve. The sensitivity, specificity, PPV, and NPV of an IJV/CCA diameter ratio of < 1.75 for predicting a CVP < 10 cm H20 were 84.62%, 52.17%, 66.67%, and 75.00%, respectively.ConclusionThe assessment of volume status by the IJV/CCA diameter ratio with a sonographic device may be a useful noninvasive alternative for a central venous catheterization with a cut-off < 1.75.
Highlights
A bedside assessment of volume status is a crucial part of patient management in critically ill patients [1]
There was a significant correlation between the internal jugular vein (IJV)/common carotid artery (CCA) diameter ratio and central venous pressure (CVP) at expiration (r=0.401, p=0.004)
There was a significant correlation between the IJV/CCA diameter ratio and CVP at expiration (r = 0.401, n = 49, p = 0.004) and a non-significant correlation at inspiration (r = 0.275, n = 49, p = 0.056) (Figure 1)
Summary
A bedside assessment of volume status is a crucial part of patient management in critically ill patients [1]. There are different invasive and noninvasive methods for volume assessment. The commonly used invasive parameters for volume assessment are pulmonary artery catheter (PAC) and central venous pressure (CVP). PAC use is becoming obsolete these days due to studies showing increased mortality with PAC placement [2]. More than 90% of intensivists use CVP to guide fluid management [3]. Some of the noninvasive modalities for volume status assessment include an ultrasonographic assessment of the inferior vena cava (IVC) collapsibility index, internal jugular or femoral vein collapsibility, and internal jugular vein/common carotid artery cross-section area [4,5,6,7,8]
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