Clinical study of internal jugular vein dilatation index in predicting septic shock volume responsiveness / 中华急诊医学杂志

ABSTRACT

Objective:To explore the value of severe ultrasound measurement of internal jugular vein dilation index (&Delta;IJV) combined with passive leg raising (PLR) in predicting the volume responsiveness of septic shock.Methods:Patients diagnosed with septic shock under complete mechanical ventilation in the ICU of Jinshan Hospital Affiliated to Fudan University from January 2020 to March 2021 were prospectively selected as the research objects. After 500 mL crystals were injected within 30 min, the patients having the "gold standard" left stroke volume (SV) increased by 15% were allocated to the volume response positive group, and patient having an SV increased by less than 15% to the volume response negative group. First, the maximum anterior posterior diameter (IJV max) and the minimum anterior posterior diameter (IJV min) in the respiratory cycle of internal jugular vein were measured by ultrasound, then SV before and after PLR was measured, and finally SV, IJV max and IJV min were measured again after rapid infusion of 500 mL crystals, and &Delta;IJV=(IJV max-IJV min)/(IJV mean)×100%. The Wilcoxon rank-sum test was used to compare the hemodynamic indexes before and after capacity expansion and PLR. Spearman rank method was used to analyze the change rate of SV (&Delta;SV) after PLR and the correlation between &Delta;IJV and &Delta;SV of the "gold standard". The sensitivity, specificity and relevant cut-off values were obtained by drawing the subject function curve to evaluate the value of &Delta;IJV and PLR in predicting the volume responsiveness of patients with sepsis. Results:A total of 56 patients were enrolled in the study, and they were divided into two groups 32 patients in the volume response positive group and 24 patients in the volume response negative group. There was a positive correlation between &Delta;IJV and &Delta;SV after capacity expansion ( r=0.778, P<0.01). Taking &Delta;IJV>17.3% as the threshold, the area under the curve (AUC) was 0.846 (95% CI 0.716~0.977), the sensitivity was 84.4% and the specificity was 83.3%. PLR was also positively correlated with &Delta;SV ( r=0.698, P<0.01). Taking &Delta;SV>15.5% after PLR as the threshold, the AUC was 0.895 (95% CI 0.796~0.993), the sensitivity was 96.9%, and the specificity was 79.2%. When &Delta;IJV combined with PLR predicted volume reactivity, the AUC was 0.944 (95% CI 0.862~1.000), the sensitivity was 99.8% and the specificity was 87.5%. Conclusions:The measurement of internal jugular vein respiratory dilation index by bedside ultrasound is a reliable index to predict volume responsiveness in patients with sepsis. When combined with PLR, the sensitivity and specificity of prediction can be improved.