Internal Jugular Vein Diameter Research Articles

Effect of transverse sinus variation on the clinical outcomes of atherosclerotic anterior circulation infarction.

BackgroundHypoplasia of the transverse sinus (TS) is a common anatomical variation. The aim of this study was to investigate the effects of TS variation (i.e., TS hypoplasia) and no variation (i.e., TS symmetry) and their subgroups on the clinical outcomes of patients with atherosclerotic anterior circulation cerebral infarction (CI).MethodsA total of 75 patients were included in the study and were divided into the no TS variation group and the TS variation group. The TS variation group was further divided into the following subgroups: the TS variation with ipsilateral CI group and the TS variation with contralateral CI group. We retrospectively analyzed the correlations of the endpoint events of patients with large atherosclerotic anterior circulation infarction and TS no variant, and subgroups of TS variants.ResultsWe found that the diameter of the ipsilateral IJV in patients with TS variants were significantly smaller than those without TS variants, which was statistically significant (P<0.05). The differences in primary endpoint events, secondary endpoint events, and responsible vessel stenosis were not statistically significant when comparing the TS variant and no TS variant groups, and the TS variant subgroup (P>0.05). We found statistically significant differences in the National Institute of Health stroke scale (NIHSS) and Modified Rankin Scale (mRS) scores after 90 days of CI between the total anterior circulation infarct (TACI) TS variant group, the ipsilateral CI TS variant group, and the partial anterior circulation infarct (PACI) TS hypoplasia group and the ipsilateral CI TS variant group (P<0.05). There was a statistically significant difference (P<0.05) between the TS variant group with TACI, the TS variant group with ipsilateral CI, and the TS no variant group and the TS variant with contralateral CI group when comparing patients’ mRS scores after 90 days of CI.ConclusionsThe diameter of the internal jugular vein (IJV) ipsilateral to the TS variant was significantly smaller than that of the TS no variant. Patients with TACI in the TS variant group and one of its subgroups (the TS variant with ipsilateral CI group) had more severe clinical symptoms and a worse prognosis than patients in the same group with PACI.

Ultrasound imaging and central venous pressure in spontaneously breathing patients: a comparison of ultrasound-based measures of internal jugular vein and inferior vena cava.

Ultrasound evaluation of inferior vena cava and internal jugular vein dia-meters predicts the intravascular volume status in critical patients. The aim of the present study was to determine which ultrasound-derived index is most strongly associated with central venous pressure (CVP). Furthermore, we determined the utility of selected variables in predicting low volume status (CVP < 8 mmHg). All patients underwent a transthoracic echocardiogram, vascular ultrasound examination, invasive central venous pressure, and intra-abdominal pressure determination. The following indexes were calculated: inferior vena cava diameter, internal jugular vein maximum diameter, collapsibility index, and internal jugular vein ratio. 41 spontaneously breathing patients were recruited. Central venous pressure significantly correlated with inferior vena cava diameter ( r = 0.35, P = 0.02), internal jugular vein ratio ( r = 0.35, P = 0.03), and internal jugular vein maximum diameter ( r = 0.58, P < 0.001). The inferior vena cava collapsibility index did not show any association. The areas under the receiver operating characteristic curves to discriminate a low central venous pressure (< 8 mmHg) were the following: internal jugular vein diameter 0.80 (95% CI: 0.63-0.90); inferior vena cava diameter 0.66 (95% CI: 0.49-0.80); and internal jugular vein ratio 0.68 (95% CI: 0.51-0.82). The internal jugular vein diameter, the internal jugular vein ratio, and the inferior vena cava diameter showed a significant correlation with central venous pressure. In particular, the internal jugular vein diameter showed good accuracy in predicting a low central venous pressure.

Internal Jugular Vein Velocity and Spontaneous Echo Contrast Correlate with Alzheimer's Disease and Cognitive Function.

Many issues persist in the today's Alzheimer's disease (AD) screening and the breakthrough method is desired. We aim to validate the association between venous reflux and AD, and to develop a new method for AD screening. We examined spontaneous echo contrast, area, diameter, retrograde velocity, and anterograde velocity of the bilateral cervical internal jugular vein (IJV) using carotid ultrasonography. A total of 112 patients participated in this study, with 26 diagnosed as AD. The proportion of both or either IJV spontaneous echo contrast (+) occupied 25 of total 26 AD patients, which showed 96.2%of sensitivity and 98.5%negative predictive value. The IJV velocities also showed significant correlation with AD diagnosis, although the IJV area or diameter did not. Our results indicate that the validation of the spontaneous echo contrast or velocities of the IJV are convenient AD diagnosis screening methods and that the venous reflux disturbance correlates with AD development.

Is There an Optimal Positive End-expiratory Pressure to Measure the Internal Jugular Vein Collapsibility Index? A Pilot Study in Mechanically Ventilated Patients

Background: Hemodynamic monitoring its early stabilization is very important in critically ill patients. Evaluating the Internal jugular vein diameter during respiratory cycles by the means of Point-of care ultrasound provides an important, easily available and precise index for monitoring hemodynamic status; a new method which is called Internal Jugular Vein Collapsibility Index (IJV-CI). Any events that alters intrathoracic volumes and pressures may affect this index. In this study we investigate the effects of various levels of positive end-expiratory pressure on this index. Methods: Thirty mechanically ventilated patients were studied. We used three different PEEP levels (0, 5 and 10 cmH2o) and point-of-care ultrasound evaluation of IJV (Internal Jugular Vein) diameter to determine the IJV-CI. The analysis were performed using SPSS V.25.0. Results: Patients were included men (76.6%) and women (33.3%). The mean age of patients was 39.65±3.4 for men and 42.71± 9.34 for women. The IJV-CI were 20.71±11.77 and 24.25±11.46 in PEEP=0 and PEEP=10 cmH20 groups respectively. In 5cmH20-PEEP group median and interquartile range were 16.45(14.8). The IJV-CI in three different PEEP levels were not statistically significantly different. Conclusion: According to the finding of this study, we found no evidence of an optimal PEEP level to measure The IJV-CI.

Effects of different intraabdominal pressures on internal jugular vein, liver and kidney functions in obese patients undergoing laparoscopic sleeve gastrectomy

Objective The aim of this study was to investigate whether there was a difference in laparoscopic sleeve gastrectomy (LSG) performed with either 10 mmHg or 13 mmHg intraabdominal pressures. Effects of these pressures on the internal jugular vein (IJV) diameter and flow along with the liver and kidney function tests were evaluated. Materials and Methods The patients were divided into two groups with respect to the intraabdominal pressure performed during LSG (either 10 or 13 mmHg). The patients’ age, comorbidities, surgical history, height, weight, body mass index, family history, duration of surgery, length of hospital stay, serum liver and kidney function tests (Urea, creatinine, Aspartate transaminase, Alanine transaminase, Gamma-glutamyltransferase, Alkaline phosphatase, bilirubin) and the right IJV diameter and flow measured by Duplex ultrasound before intubation (t1), 10 min after insufflation (t2), and at the end of insufflation (t3) were recorded. Results Preoperative and postoperative kidney and liver function values of the patients in both groups were within the reference range. In both groups, there was a significant decrease in the IJV diameter and flow measurement values at t2 compared to t1, and a significant increase was observed at t3 compared to t2 (p < 0.05). The mean IJV diameter and flow were significantly higher in the 10 mmHg pressure group compared to the 13 mmHg group (p < 0.05). Conclusion Neither of the peak pressures performed intraabdominal during LSG caused an adverse effect on liver or kidney functions. Our study emphasizes that low insufflation pressure does not have an advantage in terms of liver and kidney functions. But laparoscopic sleeve gastrectomy with low intra-abdominal pressure may be beneficial especially in patients who require central vein catheterization during the operation. We consider that LSG performed with CO2 pneumoperitoneum at 10 mmHg is a safe, effective and feasible method that can facilitate the insertion of the intraoperative central venous catheter due to lesser charges in the IJV diameter and flow compared to the standard technique.

Trendelenburg position for internal jugular vein catheterization: A systematic review and meta-analysis.

To determine the effect of Trendelenburg position on the diameter or cross-section area of the internal jugular vein (IJV) a systematic review and metanalysis was performed. Studies that evaluated the cross-sectional area (CSA) and anteroposterior (AP) diameter of the right internal jugular vein (RIJV) with ultrasonography in supine and any degree of head-down tilt (Trendelenburg position) were analyzed. A total of 22 articles (613 study subjects) were included. A >5° Trendelenburg position statistically increases RIJV CSA and AP diameter. Further inclination from 10° does not statistically benefit IJV size. This position should be recommended for CVC placement, when patient conditions allow it, and US-guided cannulation is not available.

Ultrasound Probe Positions for Internal Jugular Vein Cannulation: A Prospective Study of Different Techniques.

We compared sonoanatomy of the internal jugular vein (IJV) the high (HA), conventional (CA) and the medial oblique approach (MA) to identify the best approach and head position for IJV cannulation. Total of 45 volunteers aged 18-65 years were included in this study. The degree of overlap in percentage, depth of IJV from skin, antero-posterior (AP) and transverse diameters (TD) of IJV were measured in real time with ultrasound (US). Measurements were taken in the HA, CA and MA in neutral and 30° head rotation on both the right and left side of the neck. The HA had lower percentage of overlap when compared to CA and MA in neutral and 30° head rotation (p= 0.002 to ≤0.001). The IJV was more shallow in the CA and MA. The AP and TD of the IJV were larger in the MA when compared to HA (p=<0.001) and CA (p =0.026 to < 0.001) and the right IJV has a larger AP and TD in all approaches. The HA had the least percentage of overlap compared to CA and MA, therefore the risk of accidental ICA puncture can be reduced. The apparent overlap seen in MA may not reflect the actual scenario because of the way the US beam cuts the vessel. The AP and TD of IJV were significantly increased in the MA, which would ease CVC. We conclude and recommend the medial oblique probe position with 30° head rotation provides optimal real time sonographic parameters for US guided IJV cannulation.

Anatomical changes of the internal jugular vein with Trendelenburg position: A systematic review and meta‐analysis

Introduction The anatomy of the internal jugular vein (IJV) may be influenced by the position of the patient. A head-down-tilt or Trendelenburg position could potentially increase the size and diameter of the IJV, however, its use in clinical scenarios, such as cathetherization (a frequent procedure), is debatable. Small venous cross-section could make cannulation difficult, even while guided by ultrasound, increasing the risk of complications. The objective of this study was to systematically review all studies that analyze parameters of IJV size variations due to Trendelenburg position evaluated by ultrasound. Methods Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, all cross-sectional studies comparing the effect of Trendelenburg position were included. Any degree of head-down tilt with a supine position on the cross-sectional area (CSA) and anteroposterior (AP) diameter of the right internal jugular vein (RIJV) in healthy adults were eligible. Measurements and outcomes had to be with ultrasonography. An experienced librarian designed and conducted the search strategy in Ovid MEDLINE, EMBASE, Web of Science, Scopus, and Cochrane. Four independent reviewers, working in duplicate, assessed for eligibility of studies. Cross-sectional area (CSA) and anteroposterior (AP) diameter of the RIJV were collected and pooled using fixed-effects meta-analyses. Effect sizes are presented as mean difference (MD) and 95% confidence interval (CI). Heterogeneity between studies was assessed using the X2 test and I2 statistic. Data syntheses were conducted using Review Manager Version 5.3. Results A total of 22 articles (613 study subjects) were included. The overall risk of bias was moderate. In healthy adults, exposure to any degree of the Trendelenburg position significantly increased the CSA (MD:0.38cm²; [95% CI:0.35-0.41]; P<0.00001; I²=0%) and AP diameter (MD:1.87 mm; [95% CI:1.51-2.23]; P<0.00001; I²=0%) of the RIJV. No significant changes were exhibited when comparing the results of studies performed with the head rotated (MD:0.35cm²; [95% CI:0.29-0.42]; P<0.00001; I²=0%) with those using a neutral position of the head (MD:0.38 cm²; [95% CI:0.35-0.41]; P<0.00001; I²=0%) No significant increase of the AP diameter of the RIJV was identified from the 10° Trendelenburg position to both 15° and 20° inclinations. Conclusions The available published evidence favors Trendelenburg position, with a >5° statistically increasing RIJV CSA and AP diameter. Further inclination from 10° does not statistically benefit IJV size. This position should be recommended by international guidelines for CVC placement, when patient conditions allow it, as most guidelines fail to mention patient positioning.

Correlation of internal jugular and subclavian vein diameter variation on bedside ultrasound with invasive right heart catheterization

IntroductionAccurate estimation of fluid status is paramount in patients with heart failure. We hypothesized that bedside ultrasound assessment of the internal jugular vein (IJV) and subclavian vein (SCV) could reliably estimate right atrial pressure (RAP). MethodsProspectively enrolled patients were positioned supine. IJV was imaged at the apex of the right sternocleidomastoid muscle and SCV was imaged at the lateral third of the right clavicle. Using M-mode on a portable ultrasound machine, the maximum (Dmax) and minimum (Dmin) anteroposterior diameters were noted during normal breathing. Respiratory variation in diameter (RVD) was calculated as [(Dmax – Dmin)/Dmax] and expressed as percent. Collapsibility was assessed with sniff maneuver. Patients then underwent right heart catheterization and their findings were correlated with above. ResultsTotal of 72 patients were enrolled with mean age 61 years, mean BSA 1.9 m2, and left ventricular ejection fraction 45 ± 20%. Elevated RAP≥ 10 mmHg was associated with dilated IJV Dmax(1.0 vs. 0.7cm, p = 0.001), less RVD with resting respiration (14% vs. 40% for IJV, p = 0.001 and 24% vs. 45% for SCV, p = 0.001), and reduced likelihood of total collapsibility with sniff (16% vs. 66% patients for IJV, p = 0.001 and 25% vs. 57% patients for SCV, p = 0.01). For RAP ≥10 mmHg, lack of IJV complete collapsibility with sniff had a sensitivity of 84% while IJV Dmax > 1cm and RVD <50% had a specificity of 80%. ConclusionThe IJV and SCV diameters and their respiratory variation are reliable in estimating RA pressure.

Jugular vein diameter: A new player in normotensive pulmonary embolism

PurposeThe majority of the patients with pulmonary embolism (PE) are those with normotensive PE. Right ventricular dysfunction (RVD) and myocardial injury markers are associated with mortality although they have a low predictive impact. Here, we aim to study the performance characteristics of jugular vein diameter to predict 30-day mortality. Materials and methodsIn this prospective, observational cohort study, we included normotensive patients who were diagnosed with PE using computed tomography angiography or scintigraphy in the emergency service. The demographic characteristics, blood pressures, pulses, shock indexes, troponin and lactate levels, echocardiography findings, and internal jugular vein diameters (IJV) of the patients were recorded. Testing characteristics of IJV in predicting 30-day mortality were studied. ResultsThe mean age of the 81 patients was 66.8±16.9 years and 37% of them were male. Age, shock index, lactate, RVD, PESI, and IJV diameters during inspiration and expiration were indicators for 30-day mortality. The cut-off value obtained using the ROC curve for mortality was an IJV-exp-AP of ≤8.9 mm (sensitivity,73.3%; specificity,92.4%; +LR,9.68; −LR,0.29; NPD,93.8%; PPD,68.7%; area under the curve, 0.76; 95% confidence interval, 0.65–0.84; p=0.004). ConclusionIJV diameter is an indicator of 30-day mortality. It can be used to detect low-risk patients.

Intravascular volume assessment using internal jugular vein ultrasonography in pediatric renal transplant surgery: a prospective observational study

Purpose Assessment of the intravascular volume status during surgery is challenging, especially in pediatric patients. Ultrasound has become a versatile noninvasive modality for assessing volume status. This study aimed to evaluate the reliability of ultrasonographic internal jugular vein (IJV) dimensions as a new tool to assess the intravascular volume status in pediatric patients undergoing living donor renal transplant surgery. Patients and methods This prospective observational study included pediatric renal transplant recipients, aged 3–12 years, weighing more than 10 kg, and having an end-stage renal disease. Hemodynamic data (heart rate, systolic, diastolic, and mean blood pressures), central venous pressure (CVP), sonographic measurement of IJV (diameter and cross-sectional area), and left ventricular end-diastolic area (LVEDA) were measured 1 min after induction, before clamping of renal vessels, and after declamping of renal vessels. The correlations between the ultrasonographic IJV dimensions and both LVEDA (primary outcome) and CVP were evaluated. Results Overall, 18 pediatric patients (12 females, six males) with end-stage renal disease were eligible for this study. The mean age was 9.33±2.57 years, and the mean weight was 21.67±5.99 kg. There was a poor correlation between IJV dimensions (diameter and cross-sectional area) and both LVEDA and CVP at the three-time points of assessments. Conclusion Ultrasonographic IJV dimensions (diameter and cross-sectional area) were not reliable for assessing intravascular volume status in living donor renal transplant surgery in pediatric patients.

The effects of patient positioning on hemodynamic parameters

Elevation of legs increases stroke volume (SV) as the blood moves into the intrathoracic compartment. However, the degree of effects caused by the increase in blood remains controversial as it only has temporary effect. As for hemodynamically unstable patients, special positioning and hemodynamic monitoring are essential. We investigated the effective posture to increase SV and the relationships between the hemodynamic parameters and the changes in the SV by adjusting the upper and the lower body angles. This repeated-measures cross-sectional study included 42 normal subjects to study the relationship between SV and hemodynamic variables. Hemodynamic parameters, such as SV, end-tidal carbon dioxide (ETCO2), and anterior-posterior diameter of the inferior vena cava (IVC) and internal jugular vein (IJV) were repeatedly measured with position changes. The changes in the variables were measured in the upper body elevations of 60◦ and 30◦, the supine position, and the lower body elevations of 30◦ and 60◦. The mean SV at the 30◦ lower body elevation showed the highest value among the SV values which was measured in two minutes after each position change. The SV and the SV value change showed the strongest positive correlation with the IJV’s anterior-posterior diameter and the IJV value change (odds ratio = 5.617 and 15.277; p = 0.004 and &lt;0.001, respectively) while the ETCO2 and the IVC diameter showed no relation to the SV. The SV showed the highest value at the lower body elevation of 30◦. The scale of IJV diameter and the change were predictable factors of the SV and its changes. These findings might have clinical implications in the positioning and the hemodynamic monitoring of SV.

Ultrasound imaging of congestion in heart failure: examinations beyond the heart.

Congestion, related to pressure and/or fluid overload, plays a central role in the pathophysiology, presentation and prognosis of heart failure and is an important therapeutic target. While symptoms and physical signs of fluid overload are required to make a clinical diagnosis of heart failure, they lack both sensitivity and specificity, which might lead to diagnostic delay and uncertainty. Over the last decades, new ultrasound methods for the detection of elevated intracardiac pressures and/or fluid overload have been developed that are more sensitive and specific, thereby enabling earlier and more accurate diagnosis and facilitating treatment strategies. Accordingly, we considered that a state-of-the-art review of ultrasound methods for the detection and quantification of congestion was timely, including imaging of the heart, lungs (B-lines), kidneys (intrarenal venous flow), and venous system (inferior vena cava and internal jugular vein diameter).

Estimation of the right atrial pressure by ultrasound-assessed internal jugular vein in patients with advanced chronic heart failure

Abstract Background In patients with systolic chronic heart failure (CHF) clinical signs of congestion cannot always be evident at clinical examination. Right atrial pressure (RAP) measured by right heart catheterization (RHC) is an accurate and reproducible marker of blood volume. A non-invasive accurate tool to identify CHF patients with normal RAP would be desirable to tailor therapy. Purpose To validate an ultrasound (US)-assessed internal jugular vein distensibility (JVD) ratio to identify patients with normal mean RAP (defined as 7 mmHg or less) measured by RHC. Methods We first identify the JVD ratio that allows the most accurate identification of patients with normal RAP in a prospective calibration cohort of 100 patients with systolic CHF. Then, we tested the JVD ratio threshold to identify patients with normal RAP in a validation cohort of 101 consecutive patients with systolic CHF. All patients had a left ventricular ejection fraction (LVEF)&amp;lt;50% and underwent RHC in the setting of heart transplant work-up. At the time of jugular vein puncture, we recorded the internal jugular vein diameter by conventional linear probes. JVD ratio was calculated as the ratio between maximum diameter (during Valsalva maneuver) and rest diameter of the vein (FIGURE). Finally, we assessed the prognostic value of the JVD ratio in the follow up of the first 100 patients. Results In the calibration cohort (mean age 53 years, 13% female; median LVEF 25%, 81% in NYHA class III/IV) we define the best threshold of the JVD ratio to identify patients with normal RAP that has 1.6 with an area under the curve (AUC of 0.74; p&amp;lt;0.0001). Based on this JVD ratio threshold we defined patients with low JVD ratio (≤1.6; n=58; median RAP 8 mmHg) and patients with high JVD ratio (&amp;gt;1.6, n=42; median RAP 4 mmHg). High JVD ratio and low JVD ratio groups had similar clinical and laboratory characteristics. In the validation cohort (mean age 55 years, 13% female; median LVEF 25%; 56% in NYHA class III/IV) using the previously defined 1.6 JVD ratio threshold, we identified 51 patients with low JVD ratio (median RAP 8 mmHg) and 50 patients with high JVD ratio (median RAP 3 mmHg; p&amp;lt;0.0001) The JVD ratio threshold has an accuracy to identify patients with a normal RAP with an AUC of 0.82 (p&amp;lt;0.0001); a predictive positive value of 0.94, negative predictive value of 0.51, specificity of 0.90, and sensitivity of 0.65. Finally, in the calibration cohort, the CHF patients with low JVD ratio (≤1.6) had a higher cumulative incidence of overall death, heart transplant, or left ventricular assist device (42.7% vs. 16.1% in the high JVD ratio group, p log-rank 0.006) at a median of 13-month follow-up. Conclusions We found that US-assessed JVD ratio is a convenient and accurate diagnostic tool to identify patients with advanced systolic CHF with normal vs. increased RAP. This tool could be tested in the ambulatory setting to modulate therapies, particularly diuretics and vasodilators. Figure 1 Funding Acknowledgement Type of funding source: None

Collapsibility of the Right Internal Jugular Vein Predicts Responsiveness to Fluid Administration in Patients Receiving Pressure Support Ventilation: A Prospective Cohort Study.

BackgroundThe aim of this study was to evaluate the utility of collapsibility of the internal jugular veins (IJVs) and subclavian veins (SCVs) in comparison with collapsibility of the inferior vena cava (IVC) in patients receiving pressure support ventilation.MethodsPatients receiving pressure support ventilation were prospectively enrolled when fluid bolus administration was clinically indicated. The antero-posterior diameters of IJVs, SCVs and IVC were measured. Fluid responsiveness was defined as an 8% increase in stroke volume calculated with arterial pulse contour analysis after a passive leg raising maneuver.ResultsTwenty-seven patients (34 measurements) were included. Eighteen measurements were deemed fluid responsive. The area under the receiver operating characteristic curve of collapsibility of the right IJV antero-posterior diameter was 0.88 (95% confidence interval (CI): 0.75 - 0.99), while the area under the ROC curves for the antero-posterior diameter of the left IJV, right SCV, left SCV and the IVC were 0.57 (95% CI: 0.37 - 0.77), 0.61 (95% CI: 0.41 - 0.80), 0.55 (95% CI: 0.35 - 0.76) and 0.57 (95% CI: 0.37 - 0.77), respectively.ConclusionsThese results suggest that collapsibility of the right IJV is a useful predictor of fluid responsiveness in patients receiving pressure support ventilation. Collapsibility of the IVC did not predict fluid responsiveness in these patients.

Inpatient Evaluation of Intra-abdominal Pressure Completed With a Urinary Catheter as Compared With Ultrasonographic Vessel Measurements

Background: The purpose of this study was to evaluate the diagnostic value of ultrasonography as compared with intra-abdominal pressure (IAP) measured with a urinary catheter. Methods: This was a cross-sectional study. The participants consisted of 146 patients hospitalized in the emergency wards of two hospitals in Isfahan (2017-2018). Following measurement of IAP through a urinary catheter, ultrasonographic measurement of the inferior vena cava (IVC) diameter, internal jugular vein diameter, common femoral vein (CFV) diameter, and ratio between the IVC and abdominal aortic diameters was completed. Correlation between these methods of measurements for IAP was investigated. Results: There was a significant positive correlation between intrabladder pressure and the right internal jugular vein (RIJV) and CFV ( P &lt; .001, R &gt; 0). There was also a reverse significant correlation between intrabladder pressure and RIJV, IVC, IVC:aorta diameter, systolic blood pressure, and tricuspid annular plane systolic excursion ( P &lt; .001, r &lt; 0). RIJV, CFV, and tricuspid annular plane systolic excursion were suitable predictors for the estimation of intrabladder pressure or IAP ( P &lt; .05), but IVC, IVC:aorta, and systolic blood pressure were not suitable factors for estimating IAP ( P &gt; .05). Conclusion: Ultrasonographic measurement is a noninvasive method for determining IAP.

Capabilities of non-medicamentous sympathocorrection of the tone of cerebral veins in people with accelerated ageing

The article studies the effectiveness of the electroimpulse sympathocorrector influence on the area of the cervical sympathetic ganglia in patients with early signs of ageing. Using the ultrasound angiography method, we found that the course of sympathocorrection normalizes the diameter of internal jugular veins and contributes to improvement of cerebral venous outflow. In its turn, this implies that the development of angiodystonic changes, arterial hypertension and atherosclerosis in the organism are decelerated. The method of percutaneous electroimpulse actions in the area of the cervical sympathetic ganglia can be recommended as a way to prevent premature and accelerated ageing in the blood circulatory system and as an additional method in complex therapy.

Accuracy of respiratory variation of different vein diameters in predicting fluid responsiveness in patients with septic shock complicated with myocardial injury

Objective To evaluate the accuracy of trans-xiphoid inferior vena cava diameter variation (v-IVCTX), trans-liver inferior vena cava diameter variation (v-IVCTL), internal jugular vein diameter variation (v-IJV) and femoral vein diameter variation (v-FV) in predicting the fluid responsiveness in the patients with septic shock complicated with myocardial injury. Methods Fifty patients with septic shock complicated with myocardial depression admitted to intensive care unit of our hospital, aged ≥18 yr, were selected.The hemodynamics was monitored by PiCCO.Cardiac output (CO) and stroke volume were measured, and v-IVCTX, v-IVCTL, v-IJV and v-FV were measured by ultrasound and then calculated.Fluid replacement test was performed after meeting the standard of fluid resuscitation, and positive fluid responsiveness was defined as increase in CO after volume expansion>10%.Patients were divided into positive fluid responsiveness group and negative fluid responsiveness group.The receiver operating characteristic curve was drawn to evaluate the accuracy of the respiratory variation of each vein diameter in predicting fluid responsiveness. Results Compared with negative fluid responsiveness group, v-IVCTX, v-IVCTL and v-IJV were significantly increased (P 0.05). The cutoff value of v-IVCTX, v-IVCTL and v-IJV in predicting fluid responsiveness was 16.5%, 14.5% and 12%, respectively, the sensitivity was 80%, 76% and 84%, respectively, and the specificity was 72%, 64% and 44%, respectively.The area under the curve (95% confidence interval) of v-IVCTX, v-IVCTL and v-IJV was 0.777 (0.642-0.911), 0.741 (0.605-0.876), and 0.694 (0.549-0.838), respectively. Conclusion v-IVCTX and v-IVCTL both can predict the fluid responsiveness in the patients with septic shock complicated with myocardial injury. Key words: Shock, septic; Vascular capacitance; Inferior vena cava; Jugular veins; Femoral vein

Bedside Ultrasound in Fluid Assessment: Correlation of Internal Jugular and Subclavian Vein Diameter Variation with Invasive Right Heart Catheterization

Introduction Accurate estimation of fluid status is of paramount importance in patients with heart failure. Frequent invasive right heart catheterization is not feasible and accurate inferior vena cava imaging requires training. Internal jugular vein (IJV) and subclavian vein (SCV) could provide easier alternatives. Methods Patients scheduled to undergo right heart catheterization were prospectively enrolled in the study. Body surface area (BSA) was noted. Patient was positioned flat supine. IJV was imaged at the apex of the right sternocleidomastoid muscle and SCV was imaged at the lateral third of the right clavicle. Using M-mode on a portable ultrasound machine, the maximum (Dmax) and minimum (Dmin) anteroposterior diameters were noted during normal breathing, without applying any external pressure. Respiratory collapsibility was assessed with sniff. Respiratory variation in diameter (RVD) was calculated as: [(Dmax - Dmin)/ Dmax] and expressed as percent. Diameter variation index (DVI) was calculated as: (Dmax - Dmin)/ BSA. Results Total 72 patients enrolled with mean age 61 ± 14 years, mean BSA 2 ± 0.3m2, left ventricular (LV) ejection fraction 45 ± 20%. SCV could not be imaged in 7 patients. Elevated right atrial [RA] pressure (>=10mmHg) patients showed less RVD with resting respiration (14 vs. 41% for IJV and 24% vs. 46% for SCV, p= 0.01) and less likely to show total collapsibility with sniff (table 1). Similarly, DVI was lower with high RA pressure. Dmax alone did not correlate for SCV (table 1). For RA pressure >=10mmHg, lack of IJV collapsibility with sniff had a sensitivity of 84% and ROC area 0.75. Dmax >1cm and RVD =10mmHg. Conclusion There is a positive correlation between fluid status with IJV and SCV diameters (absolute and respiratory variation). The diagnostic performance of these veins was similar to inferior vena cava, but easier to perform.

Reduced Left Jugular Venous Remodeling and Graft Patency in a Preclinical Model

Venous remodeling, the adaptive structural and functional reorganization of the venous wall after intervention, is still not well understood. Up to 60% of arteriovenous fistulas fail to mature adequately to sustain hemodialysis as the vein fails to adequately thicken and dilate in response to arterial flow. To examine venous remodeling, we used a pig arteriovenous graft (AVG) model to expose veins to arterial flow without changing their geometry. Because humans have smaller diameter and cross-sectional area of the left internal jugular vein (IJV) compared with the right IJV, we hypothesized that left-sided AVGs may have different remodeling and patency compared with right-sided AVGs in a preclinical model. Ten Yorkshire male pigs (mean weight, 48 kg; age, 3.4 months) underwent ipsilateral or bilateral placement of AVGs from the proximal common carotid artery to the distal IJV using polytetrafluoroethylene (6 mm in diameter, 6-7 cm in length). Pigs were observed for 1 week, 2 weeks, or 3 weeks. Select pigs underwent ultrasound measurements of flow and ultrasound and caliper measurements of vessel diameters before graft placement. Vessels were harvested from two additional pigs that had undergone procedures unrelated to the IJV for control measurements. Grafts and vessels were excised and analyzed with histologic evaluation. At baseline, there was no significant difference in peak systolic or end-diastolic velocities between the left and right IJVs. The left and right IJVs also did not demonstrate any difference in caliper-measured diameters or ultrasound-measured luminal diameters. Histologic analysis of preoperative bilateral IJVs showed no difference in wall thickness or intima-media surface area. There were 10 left-sided and 8 right-sided polytetrafluoroethylene grafts placed; 4 of 10 (40%) were patent on the left and 7 of 8 (88%) were patent on the right (P = .03996, χ2 test). Postoperatively, the right IJV showed an increase in wall thickness (0.15 to 0.35 mm; P < .0001) and intima-media surface area (0.17 to 0.35 mm2; P = .0024) compared with baseline, but significant thickening was not seen on the left side. Left-sided grafts had increased luminal macrophages at the arterial anastomosis compared with right-sided grafts, but there was no significant difference in macrophage number at the venous anastomosis. Left-sided jugular veins do not thicken to the degree that right-sided veins thicken on exposure to the AVG environment. Lack of left jugular venous remodeling was associated with reduced graft patency in this preclinical model. These data suggest anatomic differences in different venous beds, emphasizing the need to understand the biology of venous remodeling to optimize graft patency.