Pediatric Intensivist Cleveland Clinic, United States
Introduction: Understanding the intravascular volume status in critically ill children is challenging. Central venous pressure (CVP) is commonly used but is invasive. Ultrasonography of both the Inferior Vena Cava (IVC) and more recently Internal Jugular Vein (IJV) have shown significant correlation with CVP in adults. Limited data exists in pediatrics, especially with IJV measurements. This study aims to correlate IJV ultrasound with CVP in mechanically ventilated post-operative children following congenital heart disease surgery.
Methods: This prospective study was conducted in the pediatric cardiac critical care unit at a tertiary children’s hospital. In addition to other variables, IJV/Common Carotid Artery (CCA) ratio at inspiration and expiration was calculated using the largest diameters of both vessels. IJV Distensibility Index was calculated as the ratio of difference in maximal IJV diameter during inspiration and minimal IJV expiratory diameter to minimal IJV expiratory diameter × 100. CVP was obtained prior to sonographic measurements. Association between CVP and IJV/CCA ratio, as well as IJV distensibility, was assessed using correlation coefficients and 95% confidence intervals.
Results: 14 patients were included, with median age of 0 months (IQR 0-7) and median CVP value of 9 (IQR 6-12). No significant correlation was found between mean airway pressure or PEEP and CVP values. No significant correlations were found between CVP and IJV/CCA ratio (R= 0.24 p= 0.40) and IJV distensibility index (R= -0.00 p= 0.99).
Conclusions: Although utilizing IJV as a surrogate of volume status may be advantageous given limited access to IVC measurements in post-operative pediatric cardiac patients, our preliminary data suggests limited utility. Larger-scale studies are needed to establish a more definitive relationship between these variables and determine clinical applicability, both in mechanically ventilated and spontaneously breathing populations.
