Yoğun Bakım Ünitesinde Yatan Hastalarda Pasif Bacak Kaldırma Öncesi ve Sonrası İnferior Vena Kava ve İnternal Juguler Ven Respiratuar Varyasyon Oranlarının Karşılaştırılması

Abstract

MELEK, Asli. A Correlation Study in the Intensive Care Unit Between the Respiratory Variation Ratios of Internal Jugular Vein and Inferior Vena Cava Before and After Passive Leg Raise. Hacettepe University Faculty of Medicine, Department of Anesthesiology and Reanimation. Residency Thesis, Ankara 2019. Assessment of fluid responsiveness is important for management of the critically ill patients. Inferior vena cava (IVC) diameter and respiratory variation ratio of IVC can be determined by ultrasonography (USG) for hemodynamic evaluation of the critically ill patient. Internal jugular vein (IJV) respiratory variation ratio has been a new parameter for hemodynamic evaluation. Aim of this study was to investigate the correlation between respiratory variation ratios of IJV and IVC before and after passive leg raise (PLR) as well as the variability between USG measurements of different physicians. After ethical committee approval, 44 mechanically ventilated, critically ill patients were enrolled into the study. We measured IJV diameter with USG in the short axis. IVC was visualized in the subxiphoid long axis. All measurements were done separately by three physicians with different USG experience levels. Measurements of IVC and IJV were done both in supine position and after PLR. Then distensibility and collapsibility indices were calculated. There were strong correlations between the physicians in all measurements (p<0.005). There wasn’t any significant correlation between distensibility and collapsibility indices of IVC and IJV in patients in supine position except the moderate correlation in the subgroup of patients with positive end expiratory pressure (PEEP) ≤5 cmH2O and strong correlation in patients on diuretics (p<0.05). There were moderate correlations between distensibility and collapsibility indices of IVC and IJV after PLR in patients without vasopressors use and strong correlations in patients on vasodilators (p>0.05). There was no correlation in other groups after PLR. Keywords: ultrasound, fluid balance, hemodynamic monitoring, inferior vena cava, jugular veins