The SONIC CENTRAL Study

CHEST Critical Care, vol. 2, pp. 100091

Abstract

Background Estimating central venous pressure (CVP) is essential in the diagnostic evaluation and treatment guidance of most hospitalized patients. It is unknown how different noninvasive, bedside methods to estimate CVP correlate with each other and which method has the best accuracy. Research Question Which noninvasive bedside method to estimate CVP has the best accuracy to detect elevated CVP? Study Design and Methods During this prospective, single-center, observational study, we included patients admitted to the ward or ICU who already had an indwelling central venous catheter and who did not undergo positive pressure ventilation. We measured height of the fluid column in the external jugular vein (EJV) according to Lewis's and Borst's method (EJV height), maximum and minimum diameters and height of the fluid column of the internal jugular vein (IJV; IJV height) using ultrasound, and diameters of the inferior vena cava (IVC) throughout a respiratory cycle and sniffing. We then compared these measurements with intravenously measured CVP. Results Ninety patients were included. Twenty-seven patients (30%) showed CVP of ≥ 10 mm Hg. All measurements had a significant correlation with CVP, except for the diameter of the IJV. Areas under the receiver operating characteristic curve for IJV height, EJV height, maximum diameter, and collapsibility on inspiration of the IVC were 0.85, 0.80, 0.78, and 0.76 respectively. The interobserver agreement was good to excellent. We estimated continuous likelihood ratios for the measurements to aid clinical decision-making. Interpretation EJV height, IJV height, IVC diameter, and IVC collapsibility can be used to identify an elevated CVP in hospitalized patients. Among these, ultrasonographic estimation of the height of the fluid column in the IJV is quick and easy and allows identification of an elevated CVP with the best reproducibility and accuracy. Trial Registry National Trial Register; No.: NL9111

Authors 6

1. Tessa A. Mulder corresponding Aachen Department of Acute Internal Medicine

   Leiden University Medical Center

   Affiliation as printed

   Department of Acute Internal Medicine, Leiden University Medical Center, The Netherlands

2. Linda Becude Aachen Department of Acute Internal Medicine Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Acute Internal Medicine, Leiden University Medical Center, The Netherlands

   Department of Cardiology, Leiden University Medical Center, The Netherlands

3. Jorge E. López Matta Aachen Department of Intensive Care Medicine

   Leiden University Medical Center

   Affiliation as printed

   Department of Intensive Care Medicine, Leiden University Medical Center, The Netherlands

4. Wilbert B. van den Hout Aachen Department of Medical Decision Making

   Leiden University Medical Center

   Affiliation as printed

   Department of Medical Decision Making, Leiden University Medical Center, The Netherlands

5. David J. van Westerloo Aachen Department of Intensive Care Medicine

   Leiden University Medical Center

   Affiliation as printed

   Department of Intensive Care Medicine, Leiden University Medical Center, The Netherlands

6. Martijn P. Bauer Aachen Department of Acute Internal Medicine

   Leiden University Medical Center

   Affiliation as printed

   Department of Acute Internal Medicine, Leiden University Medical Center, The Netherlands