Vinayak Ajeet G, Levitt Joseph, Gehlbach Brian, Pohlman Anne S, Hall Jesse B, Kress John P
Section of Pulmonary and Critical Care Medicine, Department of Medicine, The University of Chicago, Chicago, Ill, USA.
Arch Intern Med. 2006 Oct 23;166(19):2132-7. doi: 10.1001/archinte.166.19.2132.
Central venous pressure (CVP) provides important information for the management of critically ill patients. The external jugular vein (EJV) is easier to visualize than the internal jugular vein and may give a reliable estimate of CVP.
To determine the usefulness of the EJV examination in detecting abnormal CVP values, we performed a prospective blinded evaluation comparing it with CVP measured using an indwelling catheter in critically ill patients with central venous catheters. Blinded EJV examinations were performed by clinicians with 3 experience levels (attending physicians, residents and fellows, and interns and fourth-year medical students) to estimate CVP (categorized as low [</=5 cm of water] or high [>/=10 cm of water]). The usefulness of the EJV examination in discriminating low vs high CVP was measured using receiver operating characteristic curve analysis.
One hundred eighteen observations were recorded among 35 patients. The range of CVP values was 2 to 20 cm of water. The EJV was easier to visualize than the internal jugular vein (mean visual analog scale score, 8 vs 5; P<.001). The reliability for determining low and high CVP was excellent, with areas under the curve of 0.95 (95% confidence interval [CI], 0.88-1.00) and 0.97 (95% CI, 0.92-1.00), respectively, for attending physicians and 0.86 (95% CI, 0.78-0.95) and 0.90 (95% CI, 0.84-0.96), respectively, for all examiners.
The EJV examination correlates well with catheter-measured CVP and is a reliable means of identifying low and high CVP values.
中心静脉压（CVP）为危重症患者的管理提供重要信息。与颈内静脉相比，颈外静脉（EJV）更容易可视化，并且可能对CVP给出可靠的估计。
为了确定EJV检查在检测异常CVP值方面的有用性，我们进行了一项前瞻性盲法评估，将其与在有中心静脉导管的危重症患者中使用留置导管测量的CVP进行比较。由具有3个经验水平的临床医生（主治医师、住院医师和研究员以及实习生和四年级医学生）进行盲法EJV检查，以估计CVP（分为低[≤5 cm水柱]或高[≥10 cm水柱]）。使用受试者操作特征曲线分析来测量EJV检查在区分低CVP和高CVP方面的有用性。
在35例患者中记录了118次观察结果。CVP值范围为2至20 cm水柱。EJV比颈内静脉更容易可视化（平均视觉模拟量表评分，8比5；P<0.001）。确定低CVP和高CVP的可靠性极佳，主治医师的曲线下面积分别为0.95（95%置信区间[CI]，0.88 - 1.00）和0.97（95%CI，0.92 - 1.00），所有检查者的曲线下面积分别为0.86（95%CI，0.78 - 0.95）和0.90（95%CI，0.84 - 0.96）。
EJV检查与导管测量的CVP相关性良好，是识别低CVP和高CVP值的可靠方法。
