Related Experiment Video
Updated: Apr 17, 2026
Author Spotlight: Exploring Venous Waveforms in Porcine Models to Tackle Volume Overload in Medicine
Published on: January 12, 2024
Effects of incrementally increasing tidal volume on the right internal jugular vein in pediatric patients
Mehmet Sargin1, Mehmet Selçuk Uluer, Sadik Özmen
1Clinic of Anesthesiology and Reanimation, Konya Training and Research Hospital, Konya - Turkey.
Insights
Increasing tidal volume (TV) to 10 mL/kg in anesthetized children significantly increased right internal jugular vein (RIJV) size without affecting carotid artery (CA) overlap. This suggests 10 mL/kg TV is optimal for RIJV catheterization in pediatric patients.
Area of Science:
- Pediatric Anesthesiology
- Vascular Ultrasound
- Mechanical Ventilation
Background:
- Right internal jugular vein (RIJV) catheterization is a common procedure in pediatric anesthesia.
- Optimizing ventilator settings is crucial for patient safety and procedural success.
- Understanding the impact of tidal volume (TV) on vascular structures is essential.
Purpose of the Study:
- To assess the effect of increasing tidal volume (TV) on the cross-sectional area (CSA) and size of the right internal jugular vein (RIJV).
- To evaluate the relationship between RIJV size and carotid artery (CA) overlap at different TVs.
- To determine the optimal TV for RIJV catheterization in pediatric patients.
Main Methods:
- Prospective study involving 23 anesthetized pediatric patients (7-12 years).
- Tidal volume (TV) was incrementally increased from 6 to 10 mL/kg.
- Ultrasound images of RIJV and CA were captured at end-inspiration; CSA, size, and CA overlap were calculated.
Main Results:
- RIJV CSA and diameter significantly increased with TV from 6 to 10 mL/kg.
- No significant difference in CA overlap was observed across all tested TVs.
- The largest RIJV size was achieved at a TV of 10 mL/kg.
Conclusions:
- A tidal volume of 10 mL/kg maximizes RIJV size in anesthetized children.
- This TV setting does not increase carotid artery overlap, reducing potential complications.
- 10 mL/kg TV is recommended for facilitating RIJV catheterization in mechanically ventilated pediatric patients.
Purpose:
The aim of the present study was to evaluate the effects of incremental increases of tidal volume (TV) on the cross-sectional area (CSA) and size of the right internal jugular vein (RIJV), and the relationship between RIJV and the carotid artery (CA).
Methods:
This prospective study included 23 pediatric patients aged between 7 and 12 years who were anesthetized. Using a standard anesthesia protocol, the TV was increased from 6 to 10 mL/kg in 1 mL/kg increments. For each TV, images of the RIJV and CA at the level of the cricoid cartilage were recorded at the end of the inspiration. From these results, the CSA and size of the RIJV and the percentage of CA overlap were calculated.
Results:
The median (interquartile range) RIJV CSA was 0.82 (0.52-1.07) cm2 at a TV of 6 mL/kg and significantly increased to 0.86 (0.58-1.05), 0.88 (0.55-1.08), 0.95 (0.62-1.17) and 1.02 (0.70-1.20) cm2 at TVs of 7, 8, 9 and 10 mL/kg, respectively. There were no significant differences in the percentage overlap of the CA between all TVs. The median (interquartile range) transverse diameter was 1.16 (0.99-1.36) cm at a TV of 6 mL/kg and significantly increased to 1.20 (1.10-1.41), 1.26 (1.05-1.45), 1.28 (1.10-1.49) and 1.35 (1.12-1.52) cm at TVs of 7, 8, 9 and 10 mL/kg, respectively. The median (interquartile range) anteroposterior diameter was 0.77 (0.72-0.90) cm at a TV of 6 mL/kg and significantly increased to 0.81 (0.72-0.94), 0.85 (0.74-0.99), 0.88 (0.75-1.02) and 0.89 (0.79-1.06) cm at TVs of 7, 8, 9 and 10 mL/kg, respectively.
Conclusions:
This study reveals that a TV of 10 mL/kg in anesthetized children achieved the greatest size in the RIJV, and caused no difference in the CA overlap. These results suggest that a TV of 10 mL/kg is the optimal choice when facilitating catheterization and in the avoidance of complications in anesthetized children connected to mechanical ventilator that are required to undergo RIJV catheterization.
Related Concept Videos
01:22Cardiac Output II: Effect of Stroke Volume on Cardiac Output
Preload
Preload refers to the initial elongation of the cardiac myocytes before contraction and is related to the volume of blood filling the heart at the end of diastole, or end-diastolic volume. The...
01:04Venous Return
What is Venous Return?
Venous return refers to the rate at which blood flows back to the heart from the body's peripheral veins. It's an integral part of the circulatory system...
01:19Veins of Head and Neck
On the other hand, the vertebral veins, unlike their arterial counterparts, are not primarily responsible for brain drainage. Instead, they drain the cervical vertebrae, spinal cord, and some small...
01:27Assessment of the Cardiovascular System III: Palpation
Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above...
01:27Regulation of Stroke Volume
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling law of the...
01:21Cardiac Catheterization II: Right Heart Catheterization