The SONIC CENTRAL Study

CHEST critical care Pub Date : 2024-08-08 DOI:10.1016/j.chstcc.2024.100091

Tessa A. Mulder MD , Linda Becude MD , Jorge E. Lopez Matta MD , Wilbert B. van den Hout PhD , David J. van Westerloo MD, PhD , Martijn P. Bauer MD, PhD

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Abstract

Background

Estimating central venous pressure (CVP) is essential in the diagnostic evaluation and treatment guidance of most hospitalized patients. It is unknown how different noninvasive bedside methods to estimate CVP correlate with each other and which method has the best accuracy.

Research Question

Which noninvasive bedside method to estimate CVP has the best accuracy to detect elevated CVP?

Study Design and Methods

During this prospective, single-center, observational study, we included patients admitted to the ward or ICU who already had an indwelling central venous catheter and who did not undergo positive pressure ventilation. We measured height of the fluid column in the external jugular vein (EJV) according to the Lewis and Borst method (EJV height), maximum and minimum diameters and height of the fluid column of the internal jugular vein (IJV; IJV height) using ultrasound, and diameters of the inferior vena cava (IVC) throughout a respiratory cycle and sniffing. We then compared these measurements with intravenously measured CVP.

Results

Ninety patients were included. Twenty-seven patients (30%) showed CVP of ≥ 10 mm Hg. All measurements had a significant correlation with CVP, except for the diameter of the IJV. Areas under the receiver operating characteristic curve for IJV height, EJV height, maximum diameter, and collapsibility on inspiration of the IVC were 0.85, 0.80, 0.78, and 0.76 respectively. The interobserver agreement was good to excellent. We estimated continuous likelihood ratios for the measurements to aid clinical decision-making.

Interpretation

Our results indicated that EJV height, IJV height, IVC diameter, and IVC collapsibility can be used to identify an elevated CVP in hospitalized patients. Among these, ultrasonographic estimation of the height of the fluid column in the IJV is quick and easy and allows identification of an elevated CVP with the best reproducibility and accuracy.

Clinical Trial Registration

National Trial Register; ID: NL-OMON22937; URL: https://onderzoekmetmensen.nl/en/trial/22937

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SONIC CENTRAL 研究

背景估计中心静脉压（CVP）对于大多数住院患者的诊断评估和治疗指导至关重要。研究设计和方法在这项前瞻性、单中心、观察性研究中，我们纳入了已留置中心静脉导管且未接受正压通气的病房或重症监护室住院患者。我们根据刘易斯和博斯特法测量了颈外静脉（EJV）液柱的高度（EJV 高度），使用超声波测量了颈内静脉（IJV；IJV 高度）液柱的最大和最小直径和高度，以及下腔静脉（IVC）在整个呼吸周期和嗅闻过程中的直径。然后，我们将这些测量结果与静脉测量的 CVP 进行比较。27 名患者（30%）的 CVP ≥ 10 毫米汞柱。除 IJV 直径外，所有测量值均与 CVP 显著相关。IJV 高度、EJV 高度、最大直径和吸气时 IVC 的塌陷度的接收器操作特征曲线下面积分别为 0.85、0.80、0.78 和 0.76。观察者之间的一致性良好到极佳。我们估算了测量值的连续似然比，以帮助临床决策。解释我们的结果表明，EJV 高度、IJV 高度、IVC 直径和 IVC 塌陷度可用于识别住院患者的 CVP 升高。其中，用超声波估测 IJV 液柱高度既快速又简便，可用于识别 CVP 升高，且重现性和准确性最佳：NL-OMON22937; url: https://onderzoekmetmensen.nl/en/trial/22937

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来源期刊

CHEST critical care Critical Care and Intensive Care Medicine, Pulmonary and Respiratory Medicine

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