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Published on: January 13, 2023
Changes in internal jugular vein respiratory variation during tidal volume challenge predict volume responsiveness in
Mimi Wu1, Jie Xu2, Xiaojie Liu1
1Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, People's Republic of China.
Background:
Internal jugular vein respiratory variation (IJVV) has been proposed as a dynamic predictor of fluid responsiveness. However, its utility is limited in patients with low tidal volume (Vt) ventilation in the prone position. We conducted this study to determine whether a transient increase in Vt from 6 to 8 ml kg-1 of the predicted body weight (PBW), which is the "tidal volume challenge (TVC)", improves the feasibility of the IJVV in patients undergoing posterior lumbar surgery ventilated with a low Vt.
Methods:
This was a prospective study conducted in the operating room. Patients were studied at baseline (a Vt of 6 ml kg-1 PBW), during a 1 min increase in the Vt to 8 ml kg-1 of the PBW, during a 1 min shift to the Trendelenburg maneuver, and after fluid administration. Baseline values of the IJVV, pulse pressure variation (PPV), and stroke volume variation (SVV) [IJVV6, PPV6, and SVV6, respectively], and the changes in the IJVV during a TVC (ΔIJVV6-8) were measured. The change in cardiac index during a Trendelenburg maneuver (ΔCItrend) was also recorded. Volume responsiveness was defined by a ΔCItrend ≥ 8%. The primary outcome was determination of the ΔIJVV6-8 in predicting volume responsiveness during low Vt ventilation in the prone position. The secondary outcomes included an estimation of the IJVV6, PPV6, and SVV6 diagnostic performances in predicting volume responsiveness in this surgical setting.
Results:
Sixty-one patients were included in the study, 31 (50.82%) of whom were deemed volume responsive. The ΔIJVV6-8 predicted volume responsiveness with area under the receiver operating characteristic curve (AUC) of 0.96 (95% CI 0.88-0.99; P < 0.001), with a sensitivity of 96.77% and a specificity of 86.67%. In addition, the AUC for ΔIJVV6-8 was significantly higher than that for IJVV6, PPV6, and SVV6, as confirmed by DeLong's test (P = 0.04, P < 0.001, and P = 0.01, respectively).
Conclusions:
In patients undergoing posterior lumbar surgery with low Vt ventilation, changes in IJVV during a TVC effectively predict volume responsiveness and are more reliable than IJVV, PPV, and SVV in this surgical context.
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