Prospective Comparison of Noninvasive, Bedside Ultrasound Methods for Assessing Central Venous Pressure

Abstract

Purpose: To prospectively evaluate the accuracy of noninvasive central venous pressure (CVP) assessment by compression ultrasound of a forearm vein (CUS), inferior vena cava (IVC-C) and internal jugular vein collapsibility (IJV-C) compared to invasive CVP measurement (invCVP) as the gold standard.

Materials and Methods: CUS, IVC-C and IJV-C were performed in a random sequence in 81 consecutive intensive care patients with simultaneous invCVP monitoring. Examiners were blinded to invCVP and previous examinations.

Results: Median invCVP was 12.0 mmHg (range 1 – 23). CUS, IVC-C and IJV-C could be obtained in 89 %, 95 % and 100 % of cases, respectively, within a median time of 188 sec [IQR 125; 270], 133 sec [IQR 100; 211] and 60 sec [IQR 50; 109], respectively. The Spearman correlation coefficient between invCVP and CUS, IVC-C, and IJV-C was 0.485 95 %-CI [0.25; 0.65], –0.186 [–0.42; 0.07], and –0.408 [–0.59; –0.18], respectively. The median absolute difference between CUS and invCVP was 3 mmHg [IQR 2; 6.75]. CVP was categorized as low (< 7 mmHg; collapsibility > 0.6), normal (7 – 12 mmHg; collapsibility 0.6 – 0.2) and high (> 12 mmHg; collapsibility < 0.2) as prespecified. The proportions of identical CVP classifications compared to invCVP were 61.4% 95%-CI [49.3%; 72.4%] with CUS, 48.7% [37.4%; 60%] with IVC-C and 51.3% [40.3%; 62.3%] with IJV-C (p > 0.10 for all pair-wise comparisons).

Conclusion: The overall ability of CUS, IVC-C and IJV-C to assess invCVP was only moderate. CUS seems to be the preferable method if absolute CVP values are needed. IJV-C seems to be the fastest and most easily acquirable method, and thus may be especially valuable in emergency rooms.

Zusammenfassung

Ziel: Die prospektive Untersuchung der Genauigkeit der nicht invasiven Bestimmung des zentralen Venendrucks (ZVD) durch Kompressions-Ultraschall der Unterarmvene (KUS), der Kollapsibilität der Vena cava inferior (IVC-C) und der Kollapsibilität der inneren Jugularvene (IJV-C) im Vergleich zur invasiven ZVD-Messung (invZVD) als Goldstandard.

Material und Methoden: KUS, IVC-C und IJV-C wurden in zufälliger Reihenfolge bei 81 aufeinanderfolgenden Intensivpatienten mit gleichzeitiger Messung des invZVD durchgeführt. Die Untersucher waren bezüglich invZVD und allfälligen Voruntersuchungen verblindet.

Ergebnisse: Der mediane invZVD betrug 12,0 mmHg (Bereich 1 – 23). Der KUS war in 89 %, IVC-C in 95 % und IJV-C in 100 % der Fälle bestimmbar bei einer mittleren Untersuchungszeit von 188 s [IQR 125; 270] für KUS, 133 s [IQR 100; 211] für IVC-C und 60 s [IQR 50; 109] für IJV-C. Der Spearmans Rankkorrelationskoeffizient zwischen invZVD und KUS lag bei 0,485 [95 %-CI 0,25; 0,65], zwischen invZVD und IVC-C bei –0,186 [–0,42; 0,07] und zwischen invZVD und IJV-C bei 0,408 [–0,59; –0,18]. Die mediane absolute Differenz zwischen KUS und invZVD betrug 3 mmHg [IQR 2; 6,75]. Der ZVD wurde, wie vorher festgelegt, als niedrig (< 7 mmHg; Kollapsibilität > 0.6), normal (7 – 12 mmHg; Kollapsibilität 0,6 – 0,2) und hoch (> 12 mmHg; Kollapsibilität < 0.2) kategorisiert. Im Vergleich zum invZVD wurde der ZVD mittels KUS in 61.4% 95%-KI [49.3%; 72.4%] identisch kategorisiert (IVC-C 48.7% [37.4%; 60%]; IJV-C 51.3% [40.3%; 62.3%]; p > 0.10 für alle paarweisen Vergleiche).

Schlussfolgerung: Die Genauigkeit von KUS, IVC-C und IJV-C in der Bestimmung des invZVD ist nur mittelmäßig. Benötigt man absolute ZVD-Werte, so scheint KUS die Methode der Wahl zu sein. Die schnellste und am einfachsten durchführbare Methode ist die Bestimmung der IJV-C, die deshalb insbesondere auf Notfallstationen von Nutzen sein kann.

Key words

vascular - ultrasound - veins - central venous pressure

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