Kim Hee Yeong, Choi Jae Moon, Lee Yong-Hun, Lee Sukyung, Yoo Hwanhee, Gwak Mijeung
From the Department of Anesthesiology and Pain Medicine (HYK), Hangang Sacred Heart Hospital, Hallym University College of Medicine; and Department of Anesthesiology and Pain Medicine (JMC, Y-HL, SL, HY, MG), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Medicine (Baltimore). 2016 May;95(18):e3525. doi: 10.1097/MD.0000000000003525.
Catheterization of the internal jugular vein (IJV) remains difficult in pediatric populations. Increasing the cross-sectional area (CSA) of the IJV facilitates cannulation and decreases complications. We aimed to evaluate the Trendelenburg position and the levels of positive end-expiratory pressure (PEEP) at which the maximum increase of CSA of the IJV occurred in children undergoing cardiac surgery.In this prospective study, the CSA of the right IJV was assessed using ultrasound in 47 anesthetized pediatric patients with simple congenital heart defects. The baseline CSA was obtained in response to a supine position with no PEEP and compared with 5 different randomly ordered maneuvers, that is, a PEEP of 5 and 10 cm H2O in a supine position and of 0, 5, and 10 cm H2O in a 10° Trendelenburg position. Hemodynamic variables, including blood pressure and heart rate, maximum and minimum diameters, and CSA, were measured.All maneuvers increased the CSA of the right IJV with respect to the control condition. In the supine position, the CSA was increased by 9.4% with a PEEP of 5 and by 19.5% with a PEEP of 10 cm H2O. The Trendelenburg tilt alone increased the CSA by 19.0%, and combining the 10° Trendelenburg with a 10 cm H2O PEEP resulted in the largest IJV CSA increase (33.3%) compared with the supine position with no PEEP. Meanwhile, vital signs remained relatively steady during the experiment.The application of the Trendelenburg position and a 10 cm H2O PEEP thus significantly increases the CSA of the right IJV, perhaps improving the chances of successful cannulation in pediatric patients with simple congenital heart defects.
在儿科人群中，颈内静脉（IJV）置管仍然具有挑战性。增加颈内静脉的横截面积（CSA）有助于插管并减少并发症。我们旨在评估在接受心脏手术的儿童中，头低脚高位以及呼气末正压（PEEP）水平在何种情况下颈内静脉CSA会出现最大程度的增加。
在这项前瞻性研究中，对47例患有单纯先天性心脏病的麻醉儿科患者，使用超声评估右侧颈内静脉的CSA。在无PEEP的仰卧位获取基线CSA，并与5种不同的随机顺序操作进行比较，即仰卧位时PEEP为5和10 cmH₂O，以及在10°头低脚高位时PEEP为0、5和10 cmH₂O。测量包括血压、心率、最大和最小直径以及CSA在内的血流动力学变量。
与对照情况相比，所有操作均增加了右侧颈内静脉的CSA。在仰卧位时，PEEP为5时CSA增加了9.4%，PEEP为10 cmH₂O时增加了19.5%。仅头低脚高位使CSA增加了19.0%，将10°头低脚高位与10 cmH₂O的PEEP相结合，与无PEEP的仰卧位相比，导致颈内静脉CSA增加最大（33.3%）。同时，实验过程中生命体征保持相对稳定。
因此，应用头低脚高位和10 cmH₂O的PEEP可显著增加右侧颈内静脉的CSA，这可能会提高患有单纯先天性心脏病的儿科患者成功插管的几率。
