Bedside ultrasound of the internal jugular vein to assess fluid status and right ventricular function: The POCUS-JVD study

Gaurang Nandkishor Vaidya, Andrew Kolodziej, Benjamin Stoner, Josue Villegas Galaviz, Xiangkun Cao, Kory Heier, Mindy Thompson, Emma Birks, Kenneth Campbell

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background: Accurate estimation of fluid status is important in the management of heart failure patients, however, the current methods for bedside assessment can be unreliable or impractical for daily use. Methods: Non-ventilated patients were enrolled immediately prior to scheduled right heart catheterization (RHC). Using M-mode, IJV maximum (Dmax) and minimum (Dmin) anteroposterior diameters were measured during normal breathing, while supine. Respiratory variation in diameter (RVD) was calculated as [(Dmax - Dmin)/Dmax] in percentage. Collapsibility with sniff maneuver (COS) was assessed. Lastly, inferior vena cava (IVC) was assessed. Pulmonary artery pulsatility index (PAPi) was calculated. Data was obtained by five investigators. Results: Total 176 patients were enrolled. Mean BMI was 30.5 kg/m2, LVEF 14–69% (range), 38% with LVEF ≤35%. The POCUS of IJV could be performed in all patients in <5 min. Increasing RAP demonstrated progressive increase in IJV and IVC diameters. For high filling pressure (RAP ≥10 mmHg), an IJV Dmax ≥1.2 cm or IJV-RVD < 30% had specificity >70%. Combining the POCUS of IJV to physical examination improved the combined specificity to 97% for RAP ≥10 mmHg. Conversely, a finding of IJV-COS was 88% specific for normal RAP (<10 mmHg). An IJV-RVD <15% is suggested as a cutoff for RAP ≥15 mmHg. The performance of IJV POCUS was comparable to IVC. For RV function assessment, IJV-RVD < 30% had 76% sensitivity and 73% specificity for PAPi <3, while IJV-COS was 80% specific for PAPi ≥3. Conclusion: POCUS of IJV is an easy to perform, specific and reliable method for volume status estimation in daily practice. An IJV-RVD < 30% is suggested for estimation of RAP ≥10 mmHg and PAPi <3.

Original languageEnglish
Pages (from-to)151-156
Number of pages6
JournalAmerican Journal of Emergency Medicine
Volume70
DOIs
StatePublished - Aug 2023

Bibliographical note

Publisher Copyright:
© 2023 Elsevier Inc.

Keywords

  • Bedside ultrasound
  • Cardiology
  • Heart failure
  • Jugular vein
  • POCUS
  • Volume overload

ASJC Scopus subject areas

  • Emergency Medicine

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