Comparison of the effect of different degrees of passive leg raising on the internal jugular vein cross-sectional area in patients before thoracic surgery

Abstract

Background This study investigated the effect of different degrees of passive leg raising (PLR) on the internal jugular vein (IJV) cross-sectional area (CSA) and on the success rate of IJV cannulation in patients waiting for thoracic surgery, to analyze whether body mass index (BMI), gender, age, fasting time and preoperative rehydration have any impact on changes in the IJV CSA. Methods Eighty-two patients scheduled for selective thoracic surgery were enrolled in this study. Patients were randomly assigned based on a computer-generated randomization sequence into 3 groups: 0, 30, and 50 degrees ( n = 32, 25, and 25 patients, respectively). The right IJV CSA in the sequence of 0-degree (supine position), 30-degree and 50-degree PLR positions was recorded in all patients using an ultrasound probe. The relationship of BMI, gender, age, fasting time and preoperative rehydration to the IJV CSA was analyzed. Then, each patient was returned to a supine position. After waiting for at least 5 min, patients were placed in a PLR position at 0, 30, or 50 degrees, and then IJV cannulation was performed without ultrasound guidance. The success rate of IJV catheterization at different PLR angles was compared. Results The average CSA of the right IJV in the supine position, 30-degree PLR position and 50-degree PLR position was 1.39 ± 0.63 cm 2 , 1.65 ± 0.73 cm 2 , and 1.68 ± 0.71 cm 2 , respectively. These results showed gradual increases in the IJV CSA of 18.5% (30-degree PLR) and 20.2% (50-degree PLR) when compared to that in the supine position ( P = 0.045 and 0.025, respectively). However, only fasting time had a significant impact on the increase in the right IJV CSA at different PLR angles ( P = 0.026). Other factors, such as BMI, gender, age and preoperative rehydration, had no significant effects. The success rates of IJV catheterization at angles of 0, 30 and 50 degrees were 84.3, 88 and 92%, respectively; however, there were no significant differences among the three groups ( P = 0.674). Conclusions PLR increases the CSA of the right IJV, especially for patients with long fasting times before thoracic surgery. The effect of the 30-degree PLR position is similar to that of the 50-degree PLR position. However, the success rate of right IJV catheterization was not enhanced in this study using landmark-guided puncture, even though the CSA of the right IJV was increased. Trial registration Clinical trial registration number: ChiCTR1800015051 . Date of registration: March 2018.

Effect of passive leg raising on the cross-sectional area of the right internal jugular vein in patients with obesity: a randomised controlled trial protocol

“…The success rate of central venous cannulation correlates with the venous cross-sectional area (CSA) 7–10. Techniques such as positive end-expiratory pressure, the Trendelenburg position, passive leg raising (PLR): a technique to elevate the patient’s legs to increase the venous return, and the Valsalva manoeuvre have been shown to increase the CSA of the IJV in anaesthetised patients 11–15. However, most studies evaluating the impact of these manoeuvres on IJV CSA have been conducted in patients with non-obesity 16 17.…”

“…[7][8][9][10] Techniques such as positive end-expiratory pressure, the Trendelenburg position, passive leg raising (PLR): a technique to elevate the patient's legs to increase the venous return, and the Valsalva manoeuvre have been shown to increase the CSA of the IJV in anaesthetised patients. [11][12][13][14][15] However, most studies evaluating the impact of these manoeuvres on IJV CSA have been conducted in patients with non-obesity. 16 17 The effectiveness and safety of these techniques in patients with obesity remain debated, especially since studies like those by Ozkan et al have not found the Trendelenburg position to increase the CSA of the IJV in patients with obesity.…”