ObjectiveThe objective of this study is to find a correlation between internal jugular vein (IJV) and common carotid artery (CCA) diameter ratio and central venous pressure (CVP) measurement and find a cut-off value for the IJV/CCA ratio to predict low CVP i.e. < 10 cm H20, for estimating the volume status in critically ill patients.MethodsThis prospective cross-sectional study was conducted at the critical care department of Shifa International Hospital, Islamabad, from July to December 2017. A sample of 49 patients ≥ 18 years with intrathoracic central venous catheters (CVCs) who underwent bedside sonographic assessments of IJV and CCA diameter were included in this study using convenient sampling. The IJV/CCA diameter ratio was calculated and correlated with CVP and the predictive value of the IJV/CCA diameter ratio to predict CVP < 10 cm H2O was explored by calculating the area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, and positive and negative predictive values.ResultsA total of 49 patients, 30 males (61.2%) and 19 females (38.8%) with a mean age of 56.00±16.11 years were included in the study. The mean CVP was 8.98±2.37cm H2O in ventilated (51%) and 10.7± 6.01 cm H2O in non-ventilated (49%) patients. The mean IJV/CCA diameter ratio was 1.60±0.55 at expiration and 1.41±0.56 at inspiration. There was a significant correlation between the IJV/CCA diameter ratio and CVP at expiration (r=0.401, p=0.004). The correlation between IJV/CCA and CVP was significant in non-ventilated patients at expiration (r=0.439, p=0.032). The area under the ROC curve for the IJV/CCA diameter ratio for predicting CVP < 10 cm H2O was 0.684 (p=0.028). The predictive value of the IJV/CCA diameter ratio for CVP < 10 cm H20 at the cutoff value of < 2 was insignificant. A new cut-off < 1.75 was taken for the IJV/CCA diameter ratio from the coordinates of the ROC curve. The sensitivity, specificity, PPV, and NPV of an IJV/CCA diameter ratio of < 1.75 for predicting a CVP < 10 cm H20 were 84.62%, 52.17%, 66.67%, and 75.00%, respectively.ConclusionThe assessment of volume status by the IJV/CCA diameter ratio with a sonographic device may be a useful noninvasive alternative for a central venous catheterization with a cut-off < 1.75.
展开▼
机译:目的本研究的目的是发现颈内静脉(IJV)与颈总动脉(CCA)直径比和中心静脉压(CVP)测量值之间的相关性,并找到IJV / CCA比的临界值以预测低血压CVP,即<10 cm H20,用于估计危重患者的容量状况。方法这项前瞻性横断面研究于2017年7月至12月在伊斯兰堡希法国际医院重症监护室进行。样本包括49位≥18岁的患者本研究使用方便的采样方法,对接受了IJV和CCA直径床旁超声评估的胸腔内中心静脉导管(CVC)进行了多年的研究。计算IJV / CCA直径比并将其与CVP相关联,并通过计算接收器工作特性(ROC)曲线下的面积,灵敏度,特异性,IJV / CCA直径比来预测CVP <10 cm H2O的预测值。结果共有49例患者,平均年龄为56.00±16.11岁,男30例(61.2%),女19例(38.8%)。通气(51%)的平均CVP为8.98±2.37 cm H2O,非通气(49%)的患者的平均CVP为10.7±6.01 cm H2O。 IJV / CCA的平均直径比在呼气时为1.60±0.55,在吸气时为1.41±0.56。 IJV / CCA直径比与呼气末CVP之间存在显着相关性(r = 0.401,p = 0.004)。未通气的患者在呼气时IJV / CCA和CVP之间的相关性显着(r = 0.439,p = 0.032)。用于预测CVP <10 cm H2O的IJV / CCA直径比的ROC曲线下的面积为0.684(p = 0.028)。在截止值<2时,CVP <10 cm H20的IJV / CCA直径比的预测值微不足道。从ROC曲线的坐标中得出IJV / CCA直径比的新截止值<1.75。 IJV / CCA直径比<1.75预测CVP <10 cm H20的敏感性,特异性,PPV和NPV分别为84.62%,52.17%,66.67%和75.00%。超声检查装置的IJV / CCA直径比可能是临界值<1.75的中心静脉导管插入术的一种有用的无创替代方法。
展开▼