The effect of passive leg raising maneuver on right internal jugular vein diameter in ICU patients under mechanical

ventilation

M. Masjedi , M.R. Hadavi , M. Riahi alam , M.R. Sasani

Presented by : Mansoor Masjedi ; MDAssisstant professor of anesthesia & critical care consultant

Shiraz university of medical sciences , IranMilan , Italy - October , 2016

INTRODUCTION

To improve accessibility, central vein catheterization in upper body region classically done in trendelenburg position but it may impose potential disadvantages to respiratory system and disturb physiologic status of many other organs.

Passive leg raising (PLR), a simple maneuver , widely used to improve cardiac preload and to predict patients' volume responsiveness could be an alternative.

The effect of passive leg raising maneuver on right internal jugular vein diameter in ICU patients under mechanical

ventilation

OBJECTIVES In this study,

we evaluated the effect of PLR maneuver on right internal jugular vein (RIJV) diameter

in intensive care unit patients under mechanical ventilation

The effect of passive leg raising maneuver on right internal jugular vein diameter in ICU patients under mechanical

ventilation

METHODS As a prospective study , 20 pts under synchronized intermittent mandatory

ventilation (SIMV) without valvular heart dis. or heart failure and acute respiratory distress syndrome or inotrope infusion , were studied.

Measurements were at the end of inspiratory cycle with positive end expiratory pressure of 5 cmH2o.

We chose 30° PLR to keep bedridden patients away from possible damage that may be induced with higher upward slope

The effect of passive leg raising maneuver on right internal jugular vein diameter in ICU patients under mechanical

ventilation

METHODSRIJV diameter was measured with

bedside color Doppler sonography of neck ,at the level of cricoid cartilage ,with least pressure of probe on neck ,largest AP diameter plus surface area , 1st in supine position and then for 2nd & 3rd measurements , after 30° PLR for 1 and 10 minutes ,4th measurement ; 5 min. after return to pre-test position

1 2 3 4

RESULTS RIJV diameter increased with 30° PLR maneuver more prominent after 1 min. in comparison

to 10 th min. time point. Mean RIJV diameter was 11.66mm in supine, 13.37mm (P=0.001) and 12.95mm (P=0.005), 1 and 10 minutes after 30° PLR maneuver respectively . Increments in diameter were slightly lower than that associated with trendelenburg position

reported in previous studies . No complication was noted.

The effect of passive leg raising maneuver on right internal jugular vein diameter in ICU patients under mechanical

ventilation

means 10 min

CONCLUSION

PLR maneuver can be safely considered as an alternative to trendelenberg positionto increase internal jugular vein diameter

in mechanically ventilated patients

The effect of passive leg raising maneuver on right internal jugular vein diameter in ICU patients under mechanical

ventilation

8See you in Shiraz – Iran Thank You