The clinical assessment of volume status includes the observation of the jugular venous pressure wave. We examined the jugular venous pressure (JVP) in intensive care (ICU) patients and compared these values to the measured central venous pressure (CVP), utilizing a central venous catheter (CVC).
A prospective observational study was conducted in our ICU. All the clinical investigators attended a JVP assessment teaching session prior to the start of this study. Consecutive weekday patients who were admitted to the ICU and had a CVC inserted were recruited to this study. Patients who were deemed hemodynamically unstable were excluded from this study. Informed consent was obtained. The JVP was assessed in the standard method sequentially by both a staff critical care specialist and by 1-3 internal medicine residents. All physicians were blinded to the measured CVP until JVP values were recorded. The CVP was then measured at end expiration. Other variables including neck circumference, body mass index (BMI), and positive end expiratory pressure (PEEP) were recorded.
64 consecutive weekday patients in whom informed consent was obtained were enrolled. 3 patients had their CVC lines removed or left the ICU before they were studied. 39 of the patients were male. The overall value of clinical JVP assessment in determining an elevated CVP was limited with a sensitivity of 43.3% and a specificity of 67.7%. The positive predictive value was 56.5% and the negative predictive value was 55.3%. There were no differences seen in concordance between JVP and CVP regardless of PEEP settings. Evaluating accuracy in relationship to neck circumference (>40 cm, < 40 cm) did not reveal any significant differences between groups.
There was limited correlation (Pearson’s coefficient = .301) between clinical JVP measurements and CVP. There was no difference seen in concordance between the two forms of measurements in this population whether on PEEP or not.
The utility of the clinical JVP measurement in assessing increased CVP was limited in this study population.
D.D. Demeria, None.