NONİNVAZİV SANTRAL VENÖZ BASINÇ ÖLÇÜMÜ YÖNTEMLERİNİN KIYASLANMASI: İNTERNAL JUGULER VEN VE VENA CAVA İNFERİOR

Amaç Santral venöz basınç ölçümü hastaların hacim durumunu tespit etmek için etkili bir yöntemdir. Bununla birlikte, pnömotoraks gibi hayatı tehdit eden komplikasyonlar ortaya çıkabilir. Ultrasonografik ölçümlerin invaziv santral venöz basıncın bir göstergesi olarak kullanılabileceğini düşünmekteyiz. Gereç ve Yöntem Çalışmamız, Ocak 2015-Ocak 2016 tarihleri arasında, 18 yaşın üzerinde olan ve Acil Yoğun Bakım Ünitemizde internal juguler vene (IJV) santral venöz kateter yerleştirilen 81 hasta üzerinde gerçekleştirildi. İnternal juguler vendeki kanın yüksekliği, internal juguler ven kollapsibilite indeksi (IJV-Kİ) ve kaval indeks (Kİ) ultrasonografi ile ölçüldü. Daha sonra invaziv santral venöz basınç (SVB) ölçüldü ve hastalar düşük SVB ve normal SVB grupları olarak iki gruba ayrıldı ve bu üç yöntem açısından gruplar arasında istatistiksel olarak anlamlılık arandı. Bulgular Yaş ortalaması 68,58 ± 13,33 idi. Hastaların 54'ü (% 66,6) erkekti. Kırk altı hasta (% 56,8) mekanik ventilasyon altındaydı. Düşük SVB grubu 62 hastadan (% 76,5) oluştu. Ortalama invaziv SVB 4,83 ± 4,26 mmHg idi. IJV-Kİ ve invaziv SVB ile Kİ (r= 0,267, p=0,016 ve r=0,319, p=0,04), IJV yükseklik yöntemi ve Kİ ile invaziv SVB ölçümü arasında anlamlı korelasyonlar vardı (r=-0,231, p=0,03 ve r=0,357, p=0,01). Kİ ile invaziv SVB ölçümü arasında herhangi bir korelasyon izlenmedi (r = -0,010, p = 0,368). Sonuç Noninvaziv santral venöz basınç ölçüm yöntemleri invaziv santral venöz basınç düzeyleri için bir gösterge olarak kullanılabilir. IJV-Kİ, SVB'ı tahmin etmek için yararlı bir araç olabilir. IJV ölçümleri, özellikle hipovolemik hastalarda vena cava inferior ölçümlerinden daha iyi sonuç vermektedir.

Anahtar Kelimeler:

Santral venöz basınç, İnternal juguler ven, Kollapsibilite İndeksi, Vena cava inferior, Ultrason, Korelasyon

COMPARISON OF NONINVASIVE CENTRAL VENOUS PRESSURE MEASUREMENT METHODS: INTERNAL JUGULAR VEIN VERSUS VENA CAVA INFERIOR

Objective Central venous pressure measurement is an effective method to detect the volume status of the patients. However, life-threatening complications such as pneumothorax may occur. We assume that ultrasonographic measurements may be used as a surrogate of invasive central venous pressure. Materials and Methods Our study has been conducted between January 2015-January 2016 on 81 patients who were over the age of 18 and to whom a central venous catheter has been placed in the internal jugular vein (IJV) in our Emergency Intensive Care Unit. The height of the blood column in the internal jugular vein, internal jugular vein collapsibility index (IJV-CI) and the caval index (CI) of vena cava inferior have been measured by ultrasound. Then, invasive central venous pressure (CVP) has been measured and the patients were separated into two groups as low CVP and normal CVP groups and statistically significance was sought between groups in regard of these three methods. Results The mean age was 68.58±13.33 years. Fifty-four of the patients (66.6%) were male. Forty-six patients (56.8%) were mechanically ventilated. Low CVP group consisted of 62 patients (76.5%). Mean invasive CVP was 4.83±4.26 mmHg. There were significant correlations between IJV-CI and invasive CVP along with the CI (r=-0.267, p=0.016 and r=0.319, p=0.04, respectively), IJV height method and CI as well as invasive CVP measurement (r=-0.231, p=0.03 and r=0.357, p=0.01, respectively). The CI did not yield any correlation between invasive CVP measurement (r=-0.010, p=0.368). Conclusion Noninvasive central venous pressure measurement methods may be used as a surrogate for invasive central venous pressure levels. The IJV-CI may be a useful tool to estimate CVP. Measurements of IJV yields better results than the measurements from vena cava inferior (VCI) especially in volume depleted patients.

Keywords:

Central venous pressure, Internal jugular vein, Collapsibility index, Vena cava inferior, Ultrasound, Correlation,

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