Bedside internal jugular vein ultrasonography as a prognostic tool in COPD exacerbations.

Abstract

Aims: To evaluate if internal jugular vein (IJV) diameter changes, assessed by bedside ultrasonography, are associated with the severity and prognosis of Chronic Obstructive Pulmonary Disease (COPD) exacerbations, and to determine their utility in guiding clinical management in the emergency department.

Material and methods: This prospective, observational pilot study included 45 patients presenting to the emergency department with a COPD exacerbation. Patients underwent right IJV ultrasonography at presentation and 2 hours post-treatment. IJV diameters (IJVMAX, IJVMIN, IJVCOMP) and derived collapsibility indices (INDEX1, INDEX2) were measured by a single, blinded physician. Outcomes analyzed were hospital/ICU admission and 1-month mortality.

Results: 45 patients (mean age 64.96 years) were included. Following treatment, IJVMIN decreased (p=0.026) and collapsibility (INDEX1) increased significantly (p=0.002). 1-month mortality (n=4) was associated with higher post-treatment IJVCOMP2 (p=0.041). Patients admitted to the ICU (n=9) had significantly higher IJV diameters and lower collapsibility indices (p<0.05). For predicting ICU admission, IJVMIN (cut-off ≥1,05cm) had an AUC of 0.861 with 86.1% specificity.

Conclusions: Bedside IJV ultrasonography helps predict severity and monitor treatment response in COPD exacerbations. IJV parameters are associated with ICU admission and mortality, suggesting they are valuable, non-invasive decision support tools for emergency physicians.