Effects of Positive End-Expiratory Pressure on Internal Jugular Vein Cross-Sectional Area in Anesthetized Adults

Hollenbeck, Kerry J.; Schuur, Bryan M. Vander; Tulis, Matthew R.; Mecklenburg, Brian W.; Gaconnet, Cory; Wallace, Scott C.; Lujan, Eugenio; Lesnik, I.

doi:10.1213/ane.0b013e3181da92e4

Cited by 24 publications

(28 citation statements)

References 28 publications

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“…In one-third of patients PEEP of 5 cm H 2 O can increase CSA by 15.9% and PEEP of 10 cm H 2 O can increase CSA by 22% to 41%. 1,7 Trendelenburg position with 10 to 15 tilt is effective in increasing CSA of the jugular veins, a result that has been demonstrated consistently. 1,3,6,7 However, in patients with higher body mass index, clinically significant increase of the IJV CSA has not been observed with any maneuver.…”

Section: Discussionmentioning

confidence: 62%

“…1,7 Trendelenburg position with 10 to 15 tilt is effective in increasing CSA of the jugular veins, a result that has been demonstrated consistently. 1,3,6,7 However, in patients with higher body mass index, clinically significant increase of the IJV CSA has not been observed with any maneuver. 1 Investigators demonstrated achievement of clinically significant increase of > 20% of the CSA in conjunction with Trendelenburg position (39% without PEEP, 52% with PEEP of 5 cm H 2 O, and 68% with PEEP of 10 cm H 2 O).…”

Section: Discussionmentioning

confidence: 62%

“…Different methods aimed at increasing the diameter of the IJV before an attempt at cannulation have been studied, such as Trendelenburg position, head rotation at different degrees, Valsalva maneuver, and positive end-expiratory pressure (PEEP). 1,[3][4][5][6][7][8] A systematic search of the National Library of Medicine (ie, PubMed) revealed no studies comparing and reporting the cross-sectional area (CSA) of the RIJV at various anatomic levels in the neck. The aim of our study was to measure the difference in the CSA of the RIJV at 5 anatomic levels in the neck in relation to the cricoid cartilage with ultrasound in an effort to determine the level with the largest CSA suited best for venous puncture and cannulation.…”

Section: Introductionmentioning

confidence: 99%

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Right Internal Jugular Vein Cross-Sectional Area: Is There an Optimal Level for Cannulation?

Aljure

Castillo-Pedraza

Mitzova-Vladinov

et al. 2015

Journal of the Association for Vascular Access

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Background: Perioperatively, the preferred site for central venous access by anesthesia providers is the right internal jugular vein (RIJV). Maneuvers such as Trendelenburg position and positive end-expiratory pressure are commonly performed to increase the size of the RIJV and increase the success rate of cannulation. Methods: We evaluated the size of RIJV at various anatomic levels in the neck to assess the most advantageous level for cannulation with patients in a flat, supine position without use of Trendelenburg. In this study 18 healthy subjects were placed in a flat, supine position for measurements of the cross-sectional area (CSA) of the RIJV using vascular ultrasound. Three measurements were obtained at each of the 5 anatomic levels of the neck. The first baseline measurement was taken at the level of cricoid cartilage (0 cm), followed by measurements at 4 other levels: cephalad to the cricoid cartilage at þ1 and þ2 cm, and caudad to the cricoid cartilage at e1 and e2 cm. The measurements of the CSA in centimeters 2 were electronically calculated after manual anatomic outlining of the vein. Factors that may influence the RIJV size, including age, gender, and body surface area, were included in the data analysis. Results: The average CSA of the RIJV at the 5 levels measured (from þ2 to e2 cm) were 0.91, 0.97, 1.06, 1.10, and 1.14 cm 2 , respectively. The CSA of the RIJV was significantly larger at every 1-cm interval from the most cephalad level at þ2 cm to the

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 62%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Right Internal Jugular Vein Cross-Sectional Area: Is There an Optimal Level for Cannulation?

Aljure

Castillo-Pedraza

Mitzova-Vladinov

et al. 2015

Journal of the Association for Vascular Access

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show abstract

“…Hollenbeck et al [10] achieved an increase in RIJV cross-sectional area (CSA) by applying a positive-end expiratory pressure (PEEP) of 10 cmH 2 O in patients under general anesthesia, while Marcus et al [11] studied the degree of increase in RIJV CSA following the application of 5 and 10 cmH 2 O PEEP, with or without 20° of Trendelendburg tilting. These studies measured the RIJV CSA at its largest, without considering changes in CSA according to the respiratory cycle.…”

Section: Introductionmentioning

confidence: 99%

The simultaneous application of positive-end expiratory pressure with the Trendelenburg position minimizes respiratory fluctuations in internal jugular vein size

Han

et al. 2014

Korean J Anesthesiol

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BackgroundThe respiratory cycle alters the size of the right internal jugular vein (RIJV). We assessed the changes in RIJV size during the respiratory cycle in patients under positive pressure ventilation. Moreover, we examined the effects of positive-end expiratory pressure (PEEP) and the Trendelenburg position on respiratory fluctuations.MethodsA prospective study of 24 patients undergoing general endotracheal anesthesia was performed. Images of the RIJV were obtained in the supine position with no PEEP (baseline, S0) and after applying three different maneuvers in random order: (1) a PEEP of 10 cmH2O (S10), (2) a 10° Trendelenburg tilt position (T0), and (3) a 10° Trendelenburg tilt position combined with a PEEP of 10 cmH2O (T10). Using the images when the area was smallest and largest, cross-sectional area (CSA), anteroposterior diameter, and transverse diameter were measured.ResultsAll maneuvers minimized the fluctuation in RIJV size (all P = 0.0004). During the respiratory cycle, the smallest CSA compared to the largest CSA at S0, S10, T0, and T10 decreased by 28.3 8.5, 8.0, and 4.4%, respectively. Furthermore, compared to S0, a 10° Trendelenburg tilt position with a PEEP of 10 cmH2O significantly increased the CSA in the largest areas by 83.8% and in the smallest areas by 169.4%.ConclusionsA 10° Trendelenburg tilt position combined with a PEEP of 10 cmH2O not only increases the size of the RIJV but also reduces fluctuation by the respiratory cycle.

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“…These include head rotation [4], head-down tilt [5], Valsalva maneuver [6], humming [7], Trendelenburg tilt [8], abdominal compression [9], and passive leg elevation [10]. Positive end-expiratory pressure increases IJV cross-sectional area [11]. There has been no study of the effect of elevation, and there is scant guidance on how to minimize overlapping of arteries.…”

Section: Introductionmentioning

confidence: 99%

Optimal shoulder roll height for internal jugular venous cannulation: a study of awake adult volunteers

Chang

Wang

Ting

et al. 2012

Journal of Clinical Anesthesia

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Effects of Positive End-Expiratory Pressure on Internal Jugular Vein Cross-Sectional Area in Anesthetized Adults

Cited by 24 publications

References 28 publications

Right Internal Jugular Vein Cross-Sectional Area: Is There an Optimal Level for Cannulation?

Right Internal Jugular Vein Cross-Sectional Area: Is There an Optimal Level for Cannulation?

The simultaneous application of positive-end expiratory pressure with the Trendelenburg position minimizes respiratory fluctuations in internal jugular vein size

Optimal shoulder roll height for internal jugular venous cannulation: a study of awake adult volunteers

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