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Original article

Vol. 144 No. 1920 (2014)

Effects of different modes of ventilation and head position on the size of the vena jugularis interna

  • Emre Erbabacan
  • Güniz M. Köksal
  • Birsel Ekici
  • Güner Kaya
  • Fatiş Altındaş
DOI
https://doi.org/10.4414/smw.2014.13946
Cite this as:
Swiss Med Wkly. 2014;144:w13946
Published
04.05.2014

Summary

PURPOSE: Right internal jugular vein (RIJV) catheterisation is a common procedure in patients undergoing surgery. We aimed to compare diameters and the cross-sectional area (CSA) of the RIJV when the head is in a neutral or 30-degree rotated position during mechanical ventilation in various modes and spontaneous ventilation.

METHODS: Thirty patients undergoing surgery were included in the study. In each patient, still ultrasound images of the vena jugularis interna were taken with the head in a neutral position and with the neck rotated 30 degrees to the left, first under spontaneous ventilation (group S), then after the induction of anaesthesia under volume-controlled ventilation (group V) and under pressure-controlled ventilation (group P). The six still images were evaluated in terms of transverse and anteroposterior diameters and CSA.

RESULTS: Diameters in the neutral and lateral positions in group S were significantly smaller than in group P and group V (neutral transverse p = 0.01, anteroposterior p = 0.041, rotated transverse p = 0.01, anteroposterior p = 0.03). The CSAs of the RIJV in the neutral and lateral positions were significantly larger in group P and group V than Group S (lateral CSA p = 0.001, neutral CSA p = 0.002). CSA increased significantly only in group P when the head was rotated 30 degrees laterally (p = 0.002).

CONCLUSION: We conclude that both pressure-controlled and volume-controlled mechanical ventilation have similar effects on the CSA and diameters of the RIJV. Positioning of the head with a 30-degree rotation laterally has different effects on CSA depending on the ventilation mode used. A neutral position should be preferred with spontaneous ventilation whereas 30 degree rotation should be preferred in patients under pressure-controlled and volume-controlled ventilation.

Clinical trial registration number at ClinicalTrials.gov: NCT01790334

References

  1. Lobato EB, Florete OG Jr, Paige GB, Morey TE. Cross-sectional area and intravascular pressure of the right internal jugular vein during anesthesia: effects of trendelenburg position, positive intrathoracic pressure, and hepatic compression. J Clin Anesth. 1998;10(1):1–5.
  2. Chittoodan S, Breen D, O’Donnell BD, Iohom G. Long versus short axis ultrasound guided approach for internal jugular vein cannulation: a prospective randomised controlled trial. Med Ultrasound. 2011;13(1):21–5.
  3. Hayashi H, Ootaki C, Tsuzuku M, Amano M. Respiratory jugular venodilation: a new landmark for right internal jugular vein punctures in ventilated patients. J Cardiothorac Vasc Anesth. 2000;14(1):40–4.
  4. Lamperti M, Subert M, Cortellazzi P, Vailati D, Borrelli P, Montomoli C, et al. Is a neutral head position safer than 45-degree neck rotation during ultrasound-guided internal jugular vein cannulation? Results of a randomized controlled clinical trial. Anesth Analg. 2012;114(4):777–84
  5. Wang R, Snoey ER, Clements RC, Hern HG, Price D. Effect of head rotation on vascular anatomy of the neck: an ultrasound study. J Emerg Med. 2006;31(3):283–6.
  6. Mey U, Glasmacher A, Hahn C, Gorschlüter M, Ziske C, Mergelsberg M, et al. Evaluation of an ultrasound-guided technique for central venous access via the internal jugular vein in 493 patients. Support Care Cancer. 2003;11(3):148–55.
  7. Bellazzini MA, Rankin PM, Gangnon RE, Bjoernsen LP. Ultrasound validation of maneuvers to increase internal jugular vein cross-sectional area and decrease compressibility. Am J Emerg Med. 2009;27(4):454–9.
  8. Marcus HE, Bonkat E, Dagtekin O, Schier R, Petzke F, Wippermann J, et al. The impact of trendelenburg position and positive end-expiratory pressure on the internal jugular cross-sectional area. Anesth Analg. 2010;111(2):432–6.
  9. Hollenbeck KJ, Vander Schuur BM, Tulis MR, Mecklenburg BW, Gaconnet CP, Wallace SC, et al. Brief report: effects of positive end-expiratory pressure on internal jugular vein cross-sectional area in anesthetized adults. Anesth Analg. 2010;110(6):1669–73.
  10. Karakitsos D, Labropoulos N, De Groot E, Patrianakos AP, Kouraklis G, Poularas J, et al. A. Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. Crit Care. 2006;10(6):R162.
  11. Trautner H, Greim CA, Arzet H, Schwemmer U, Roewer N. Ultrasound-guided central venous cannulation in neuropaediatric patients to avoid measures causing potential increase in brain pressure. Anaesthesist. 2003;52(2):115–9.
  12. Suarez T, Baerwald JP, Kraus C. Central venous access: the effects of approach, position, and head rotation on internal jugular vein cross-sectional area. Anesth Analg. 2002;95(6):1519–24.