Internal jugular vein collapsibility does not predict fluid responsiveness in spontaneously breathing patients after cardiac surgery

Horejsek, Jan; Balík, Martin; Kunstýř, Jan; Michálek, Pavel; Kopecký, Petr; Brožek, Tomáš; Bartošová, Tereza; Fink, Adam; Waldauf, Petr; Porizka, Michal

doi:10.1007/s10877-023-01066-6

Cited by 4 publications

(1 citation statement)

References 41 publications

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“…Additionally, a study indicated that IJV collapsibility could reliably predict hypovolemia in patients with spontaneous breathing 29 . However, contrasting findings have emerged, suggesting that IJV collapsibility may not effectively predict fluid responsiveness in spontaneously breathing patients, as indicated by our results 30 . This inconsistency might be due to the influence of thoracic or intra-abdominal pressures on the IJV during spontaneous breathing, which could compromise measurement accuracy 5 .…”

Section: Discussionmentioning

confidence: 56%

Prediction of fluid responsiveness in spontaneously breathing patients with hemodynamic stability: a prospective repeated-measures study

Kim,

Lee

2024

Sci Rep

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Evaluating fluid responsiveness with dynamic parameters is recommended for fluid management. However, in hemodynamically stable patients who are breathing spontaneously, accurately measuring stroke volume variation via echocardiography and passive leg raising is challenging due to subtle SV changes. This study aimed to identify normal SV changes in healthy volunteers and evaluate the precision of hemodynamic parameters in screening mild hypovolemia in patients. This prospective, repeated-measures, cross-sectional study screened 269 subjects via echocardiography. Initially, 45 healthy volunteers underwent a fluid challenge test, the outcomes of which served as criteria to screen 215 ICU patients. Among these patients, 53 underwent additional fluid challenge testing. Hemodynamic parameters, including medians of maximum velocity time integrals (VTImaxs), peak velocity of VTImax (PV), internal jugular vein diameters (IJVD), and area (IJVA) were repeatedly measured first at a 60° upper body elevation (UBE), second in a supine position, third at UBE, fourth in a supine position, and lastly in a supine position after fluid loading. The hemodynamic responses to the position changes were compared between 83 fluid non-responders and 15 fluid responders. Fluid responsiveness was defined as fluid-induced medians’ change of VTImaxs (fluid-induced median VTImax change) ≥ 10%. None of the healthy volunteers showed the mean value of repeatedly measured medians of VTImaxs ≥ 7%, following either UBE position (UBE-induced median VTImax change) or fluid loading (fluid-induced median VTImax change). UBE-induced median VTImax and PV changes were significantly correlated with fluid responsiveness (p < 0.001, AUC 0.959; p < 0.001, AUC 0.804). The significant correlations were demonstrated via multivariable analysis using binary logistic regression (p = 0.001, OR 90.1) and the correlation coefficient (R2 = 0.793) using linear regression analysis. UBE-induced median VTImax changes (≥ 11.8% and 7.98%) predicted fluid-induced median VTImax changes ≥ 10% and 7% (AUC 0.959 and 0.939). The collapsibility and variation of IJVD and IJVA showed no significant correlation. An increase in the mean value of medians of repeatedly measured VTImaxs transitioning from an UBE to a supine position, effectively screened mild hypovolemia and demonstrated a significant correlation with fluid responsiveness in spontaneously breathing patients maintaining hemodynamic stability.

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Section: Discussionmentioning

confidence: 56%

Prediction of fluid responsiveness in spontaneously breathing patients with hemodynamic stability: a prospective repeated-measures study

Kim,

Lee

2024

Sci Rep

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Systematic Review and Meta-Analysis of Internal Jugular Vein Variants and Their Relationship to Clinical Implications in the Head and Neck

Nova-Baeza,

Valenzuela-Fuenzalida,

Valdivia-Arroyo

et al. 2024

Diagnostics

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Background: The internal jugular vein (IJV) is a vascular structure that is responsible for the venous drainage of both the head and neck and is commonly found posterior to the internal carotid artery and adjacent to cervical lymph nodes or nerve structures such as the glossopharyngeal and accessory nerves. As a vagal nerve, it is an important reference point for surgical access in neck interventions and dissections. Methods: The databases Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS were searched until August 2024. Methodological quality was evaluated with an assurance tool for anatomical studies (AQUA). Pooled prevalence was estimated using a random effects model. Results: A total of 10 studies met the established selection criteria in this meta-analysis study. The prevalence of variants of the IJV was 3.36% (CI: 2.81–6.96%), with a heterogeneity of 94.46%. Regarding the subgroup analysis, no study presents statistically significant differences in the studies analyzed for this review. Conclusions: Knowing the IJV variants in detail will make early diagnosis useful, especially in surgeries in the neck region and in classic surgeries such as thyroidectomies and tracheostomies, among others. It will be important to know the position of the IJV.

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Year 2023 in review - Cardiac anaesthesia and postoperative care

Michálek,

Říha,

Kunstýř

et al. 2023

Anest. intenziv. Med.

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Internal jugular vein collapsibility does not predict fluid responsiveness in spontaneously breathing patients after cardiac surgery

Cited by 4 publications

References 41 publications

Prediction of fluid responsiveness in spontaneously breathing patients with hemodynamic stability: a prospective repeated-measures study

Prediction of fluid responsiveness in spontaneously breathing patients with hemodynamic stability: a prospective repeated-measures study

Systematic Review and Meta-Analysis of Internal Jugular Vein Variants and Their Relationship to Clinical Implications in the Head and Neck

Year 2023 in review - Cardiac anaesthesia and postoperative care

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