Usefulness of the external jugular vein examination in detecting abnormal central venous pressure in critically ill patients

Ajeet G VINAYAK; Joseph LEVITT; Brian GEHLBACH; Anne S POHLMAN; Jesse B HALL; John P KRESS

doi:10.1001/archinte.166.19.2132

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Usefulness of the external jugular vein examination in detecting abnormal central venous pressure in critically ill patients

Journal article

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Usefulness of the external jugular vein examination in detecting abnormal central venous pressure in critically ill patients

Ajeet G VINAYAK, Joseph LEVITT, Brian GEHLBACH, Anne S POHLMAN, Jesse B HALL and John P KRESS

Archives of internal medicine (1960), Vol.166(19), pp.2132-2137

2006

DOI: 10.1001/archinte.166.19.2132

PMID: 17060544

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Abstract

Background: Central venous pressure (CVP) provides important information for the management of critically ill patients. The external jugular vein (EJV) is easier to visualize than the internal jugular vein and may give a reliable estimate of CVP. Methods: To determine the usefulness of the EJV examination in detecting abnormal CVP values, we performed a prospective blinded evaluation comparing it with CVP measured using an indwelling catheter in critically ill patients with central venous catheters. Blinded EJV examinations were performed by clinicians with 3 experience levels (attending physicians, residents and fellows, and interns and fourth-year medical students) to estimate CVP (categorized as low [</=5 cm of water] or high [>/=10 cm of water]). The usefulness of the EJV examination in discriminating low vs high CVP was measured using receiver operating characteristic curve analysis. Results: One hundred eighteen observations were recorded among 35 patients. The range of CVP values was 2 to 20 cm of water. The EJV was easier to visualize than the internal jugular vein (mean visual analog scale score, 8 vs 5; P<.001). The reliability for determining low and high CVP was excellent, with areas under the curve of 0.95 (95% confidence interval [CI], 0.88-1.00) and 0.97 (95% CI, 0.92-1.00), respectively, for attending physicians and 0.86 (95% CI, 0.78-0.95) and 0.90 (95% CI, 0.84-0.96), respectively, for all examiners. Conclusion: The EJV examination correlates well with catheter-measured CVP and is a reliable means of identifying low and high CVP values.

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Title: Subtitle: Usefulness of the external jugular vein examination in detecting abnormal central venous pressure in critically ill patients
Creators: Ajeet G VINAYAK - Section of Pulmonary and Critical Care Medicine, Department of Medicine, The University of Chicago, Chicago, Ill, United States
Joseph LEVITT - Section of Pulmonary and Critical Care Medicine, Department of Medicine, The University of Chicago, Chicago, Ill, United States
Brian GEHLBACH - Section of Pulmonary and Critical Care Medicine, Department of Medicine, The University of Chicago, Chicago, Ill, United States
Anne S POHLMAN - Section of Pulmonary and Critical Care Medicine, Department of Medicine, The University of Chicago, Chicago, Ill, United States
Jesse B HALL - Section of Pulmonary and Critical Care Medicine, Department of Medicine, The University of Chicago, Chicago, Ill, United States
John P KRESS - Section of Pulmonary and Critical Care Medicine, Department of Medicine, The University of Chicago, Chicago, Ill, United States
Resource Type: Journal article
Publication Details: Archives of internal medicine (1960), Vol.166(19), pp.2132-2137
DOI: 10.1001/archinte.166.19.2132
PMID: 17060544
NLM abbreviation: Arch Intern Med
ISSN: 0003-9926
eISSN: 1538-3679
Publisher: American Medical Association; Chicago, IL
Language: English
Date published: 2006
Academic Unit: Neurology; Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
Record Identifier: 9984020723802771

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