Cardiac variation of internal jugular vein for the evaluation of intravascular water volume

2020 Fiscal Year Final Research Report

• Project/Area Number: 19K18314
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 55060:Emergency medicine-related
• Research Institution: The University of Tokyo
• Principal Investigator: Nakamura Kensuke 東京大学, 医学部附属病院, 届出研究員 (50466760)
• Project Period (FY): 2019-04-01 – 2021-03-31
• Keywords: 循環動態 / 心拍出量 / 血管内水分量 / エコー / 超音波 / 脱水 / 内頸静脈 / 心拍変動

Outline of Final Research Achievements

We investigated whether cardiac variations in the internal jugular vein (IJV), evaluated by ultrasound, predict fluid responsiveness in patients in the emergency department. Patients visited the emergency department between August 2019 and March 2020 and required infusions were enrolled. We recorded a short-axis video of IJV, respiratory variability in the inferior vena cava, and stroke volume (SV) and stroke volume variations (SVV) using ClearSight before the infusion of 500 mL of crystalloid fluid. Cardiac variations in the cross-sectional area of IJV were measured by speckle tracking. Among the 148 patients enrolled, 105 were included in the final analysis. The cardiac collapse index did not correlate with fluid responsiveness (13.6 vs 16.8%, p=0.24), but correlated with SVV (12.5 vs. 15.6%, p=0.026). The cardiac collapse index correlated with SV corrected by age (r=0.25, p=0.01), body surface area (r=0.33, p=0.002), and both (r=0.35, p=0.001).

Free Research Field

救急医学、集中治療医学

Academic Significance and Societal Importance of the Research Achievements

血管内水分量の正確な測定には肺動脈カテーテルや経肺熱希釈法など侵襲的かつ特別な装置を使用した方法が用いられている。しかし、臨床現場においては簡便かつ非侵襲的な血管内水分量の評価法が必要とされる。超音波での下大静脈の呼吸性変動や下肢挙上試験など非侵襲的な方法が報告されているが、完璧な方法はなく、簡便・迅速かつ非侵襲的な評価法の種類を増やすことには大きな意義がある。我々は超音波で安定して評価可能な内頚静脈の心拍変動に注目し、今回は初めて臨床現場での意義を検討した。今回は輸液反応性の予測はできなかったが、1回心拍出量との相関を認めており、今後さらなる検討を重ね、この手法が臨床応用を目指していく。