Effect of Positive End Expiratory Pressure on Central Venous Pressure in Mechanically Ventilated Patients

Background: Ultrasound guided fluid assessment in management of septic shock has come up as an adjunct to the current gold standard Central Venous Pressure monitoring. This study was designed to observe the respiro-phasic variation of IVC diameter (RV-IVCD) in invasively mechanically ventilated and spontaneously breathing paediatric patients of fluid refractory septic shock.Methods: This was a prospective observational study done at Paediatric intensive Care Unit (PICU) in Paediatric ward of Jawaharlal Nehru Medical College and Hospital (JNMCH) from February 2016 to June 2017. 107 consecutive patients between 1 year to 16 years age who were in shock despite 40ml/kg of fluid administration were included. Inferior Vena Cava (IVC) diameters were measured at end-expiration and end inspiration and the IVC collapsibility index was calculated. Simultaneously Central Venous Pressure (CVP) was recorded. Both values were obtained in ventilated and non-ventilated patients. Data was analysed to determine to look for the profile of RV-IVCD and CVP in ventilated and non-ventilated cases.Results: Out of 107 patients, 91 were on invasive mechanical ventilation and 16 patients were spontaneously breathing. There was a strong negative correlation between central venous pressure (CVP) and inferior vena cava collapsibility (RV-IVCD) in both spontaneously breathing (-0.810) and mechanically ventilated patients (-0.700). Negative correlation was significant in both study groups in CVP <8 mmHg and only in spontaneously breathing patients in CVP 8-12 mmHg range. IVC collapsibility showed a decreasing trend with rising CVP in both spontaneously breathing and mechanically ventilated patients.Conclusion: Ultrasonography guided IVCCI appears to be a valuable index in assessing fluid status in both spontaneously breathing and mechanically ventilated septic shock patients. However, more data is required from the paediatric population so as to define it as standard of practice.

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Comparison between femoral vein diameter and inferior vena cava diameter by ultrasound in estimation of central venous pressure in mechanically ventilated patients

Research and Opinion in Anesthesia and Intensive Care ◽

10.4103/roaic.roaic_1_19 ◽

2020 ◽

Vol 7 (1) ◽

pp. 100

Author(s):

Dina Zidan ◽

Ayman Baess

Keyword(s):

Inferior Vena ◽

Femoral Vein ◽

Venous Pressure ◽

Vena Cava ◽

Central Venous ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Vein Diameter ◽

Inferior Vena Cava Diameter ◽

Ventilated Patients

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

Archives of Anesthesia and Critical Care ◽

10.18502/aacc.v7i4.7628 ◽

2021 ◽

Author(s):

Alireza Zeraatchi ◽

Taraneh Naghibi ◽

Hamid Kafili ◽

Somayeh Abdollahi Sabet

Keyword(s):

Internal Jugular Vein ◽

Jugular Vein ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Positive End Expiratory Pressure ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Collapsibility Index ◽

Vein Diameter ◽

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.

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