Document Type: Original Article

Authors

1 Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

2 Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran

Abstract

Objective: Fluid resuscitation is necessary in almost all critical patients. The central venous pressure (CVP) is a well-established method of assessing resuscitation. Recently, there have been attempts to investigate less invasive methods like the diameters of inferior vena cava (IVC) or the jugular vein. We aimed to investigate this method in our research.
Methods: Seventy eight critical patients admitted to the emergency department from April 2018 to December 2018 were studied. The CVP was measured along with the diameters of the two mentioned veins before and during resuscitation. The urinary output was also recorded after administering the fluid. The minimum p-value that would illustrate a significant association was equal to 0.05.
Results: Findings showed that 53.8% of patients were males and 46.2% were females with an average age of 71.48 years. The causes of the critical state were 25.6% hemorrhagic shocks, 30.8% septic shocks and 43.6% hypovolemic shocks. The mean diameter of the jugular vein before and during resuscitation was 27.21 mm and 25.38 mm, respectively (P = 0.1). The mean of IVC diameter before and during resuscitation was 63.33 mm and 57.98 mm, respectively (P <0.001). The CVP was 4.23 mmHg before resuscitation and 5.61 mmHg after resuscitation (P <0.001). With an average urine output of 201.28 cc, a significant correlation was observed with the increase in the CVP, while no such correlations were observed with the decreasing state of the diameters of the IVC or the jugular vein.
Conclusion: Both the IVC diameter and the jugular vein diameter are unable to assess fluid resuscitation independently from respiratory factors

Keywords

Main Subjects

1. Haliloglu M, Bilgili B, Kararmaz A, Cinel I. The value of internal jugular vein collapsibility index in sepsis. Ulus Travma Acil Cerrahi Derg 2017; 23(4): 294-300. doi:10.5505/tjtes.2016.04832.
2. Marik P, Bellomo R. A rational approach to fluid therapy in sepsis. Br J Anaesth 2016; 116(3): 339-49. doi: 10.1093/bja/aev349.
3. Ma GG, Hao GW, Yang XM, Zhu DM, Liu L, Liu H, et al. Internal jugular vein variability predicts fluid responsiveness in cardiac surgical patients with mechanical ventilation. Ann Intensive Care 2018; 8(1): 6. doi: 10.1186/s13613-017-0347-5.
4. Correa TD, Rocha LL, Pessoa CM, Silva E, de Assuncao MS. Fluid therapy for septic shock resuscitation: which fluid should be used? Einstein (Sao Paulo) 2015; 13(3):462-8. doi: 10.1590/s1679-45082015rw3273.
5. Patil S, Jadhav S, Shetty N, Kharge J, Puttegowda B, Ramalingam R, et al. Assessment of inferior vena cava diameter by echocardiography in normal Indian population: a prospective observational study. Indian Heart J 2016; 68 suppl 3: S26-30. doi: 10.1016/j.ihj.2016.06.009.
6. Lall K, Roberts G, Buehner U. Fluid resuscitation in critically ill patients-timing and dose matters. Anaesth Intensive Care 2017; 45(4): 518-23. doi:10.1177/0310057x1704500417.
7. Finfer S, Liu B, Taylor C, Bellomo R, Billot L, Cook D, et al. Resuscitation fluid use in critically ill adults: an international cross-sectional study in 391 intensive care units. Crit Care 2010; 14(5): R185. doi: 10.1186/cc9293.

8. Basso F, Berdin G, Virzi GM, Mason G, Piccinni P, Day S, et al. Fluid management in the intensive care unit: bioelectrical impedance vector analysis as a tool to assess hydration status and optimal fluid balance in critically ill patients. Blood Purif 2013; 36(3-4): 192-9. doi: 10.1159/000356366.
9. Hartog CS, Welte T, Schlattmann P, Reinhart K. Fluid replacement with hydroxyethyl starch in critical care--a reassessment. Dtsch Arztebl Int 2013; 110(26): 443-50. doi: 10.3238/arztebl.2013.0443.
10. Guarracino F, Ferro B, Forfori F, Bertini P, Magliacano L, Pinsky MR. Jugular vein distensibility predicts fluid responsiveness in septic patients. Crit Care 2014; 18(6):647. doi: 10.1186/s13054-014-0647-1.
11. Airapetian N, Maizel J, Alyamani O, Mahjoub Y, Lorne E, Levrard M, et al. Does inferior vena cava respiratory variability predict fluid responsiveness in spontaneously breathing patients? Crit Care 2015; 19: 400. doi: 10.1186/s13054-015-1100-9.
12. Sasai T, Tokioka H, Fukushima T, Mikane T, Oku S, Iwasaki E, et al. Reliability of central venous pressure to assess left ventricular preload for fluid resuscitation in patients with septic shock. J Intensive Care 2014; 2(1): 58. doi: 10.1186/s40560-014-0058-z.