Background

Bedside ultrasound helps to estimate volume status in critically ill patients and has traditionally relied on diameter, respiratory variation, and collapsibility of the inferior vena cava (IVC) to reflect fluid status. We evaluated collapsibility of the internal jugular vein (IJ) with ultrasound and correlated it with concomitant right heart catheterization (RHC) measurements in patients with presumed pulmonary hypertension.

Methods and results

We studied 71 patients undergoing RHC for evaluation of pulmonary hypertension. Using two-dimensional ultrasound (Sonosite, Washington, USA), we measured the diameter of the IJ at rest, during respiratory variation, and during manual compression. Collapsibility index during respiration (respiratory CI) and during manual compression (compression CI) was calculated. We correlated mean right atrial pressure (mRAP) and pulmonary artery occlusion pressure (PAOP) defined by RHC measurements with respiratory and compression CI. A secondary goal was examining correlations between CI calculations and B-type natriuretic peptide (BNP) levels. Baseline characteristics demonstrated female predominance (n = 51; 71.8%), mean age 59.5 years, and BMI 27.3. There were significant correlations between decrease in compression CI and increase in both mRAP (Spearman: − 0.43; p value = 0.0002) and PAOP (Spearman: − 0.35; p value = 0.0027). In contrast, there was no significant correlation between respiratory CI and either mRAP (Spearman: − 0.14; p value = 0.35) or PAOP (Spearman:− 0.12; p value = 0.31). We also observed significant negative correlation between compression CI and BNP (Spearman: − 0.31; p value = 0.01) but not between respiratory CI and BNP (Spearman: − 0.12; p value = 0.35).

Conclusion

Increasing use of ultrasound has led to innovative techniques for estimating volume status. While prior ultrasound studies have used clinical parameters to estimate fluid status, our study used RHC measurements and demonstrated that compression CI potentially reflects directly measured mRAP and PAOP.

中文翻译：

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使用超声测量的颈内静脉可折叠性指数确定假定的肺动脉高压患者的静态心内压

背景

床旁超声有助于估计危重患者的容量状态，并且传统上依靠直径，呼吸变化和下腔静脉（IVC）的可折叠性来反映体液状态。我们用超声评估了颈内静脉（IJ）的可折叠性，并将其与估计的肺动脉高压患者同时进行的右心导管检查（RHC）相关联。

方法与结果

我们研究了71名接受RHC治疗的患者，以评估其肺动脉高压。使用二维超声（Sonosite，华盛顿，美国），我们测量了静息，呼吸变化和手动压迫期间IJ的直径。计算了呼吸期间（呼吸CI）和手动压迫期间（压缩CI）的可折叠性指数。我们将通过RHC测量定义的平均右心房压力（mRAP）和肺动脉闭塞压力（PAOP）与呼吸和压迫CI相关联。第二个目标是检查CI计算与B型利钠肽（BNP）水平之间的相关性。基线特征显示女性占主导地位（n = 51; 71.8％），平均年龄59.5岁和BMI 27.3。压缩CI的降低与mRAP（Spearman：-0.43; p值= 0.0002）和PAOP（Spearman：-0.35; p值= 0.0027）的增加之间存在显着相关性。相反，呼吸道CI与mRAP（Spearman：− 0.14; p值= 0.35）或PAOP（Spearman：− 0.12; p值= 0.31）之间无显着相关性。我们还观察到压缩CI和BNP之间的显着负相关（Spearman：-0.31；p值= 0.01），但呼吸CI和BNP之间没有显着的负相关（Spearman：-0.12；p值= 0.35）。

结论

越来越多地使用超声波导致了估计体积状态的创新技术。虽然先前的超声研究已经使用临床参数来估计体液状况，但我们的研究使用了RHC测量值，并证明了压缩CI可能反映了直接测量的mRAP和PAOP。