Question and Methods: Using a convenience sample of 100 patients out of 4436 going for right heart catheterization in 2 US academic hospitals, the authors wanted to validate the accuracy of quantitative and qualitative point-of-care ultrasonography assessment of jugular venous pressure (JVP) in predicting elevated central venous pressure (CVP) on invasive monitoring.
Findings: the authors found that a uJVP measurement of >8cm with patients in a semi-recumbent position is 72.7% sensitive (95% CI, 57.2% to 85.0%) and 78% specific (95% CI, 65.6% to 88.4%) for a CVP >10mmHg, giving an ROC of 0.84 (95% CI, 0.76 to 0.92). This increased to 94.6% specific (95% CI, 85.1% to 98.9) in the upright position. Both had high interrater reliability of 0.97 (95% CI, 0.84 to 0.98).
Limitations: very narrow pre-selected population. Only 3 expert sonographers used to take the measurements. Lack of calibration of the right heart catheter measurements. Significant over/under estimation in obese patients. Did not account for vascular or valvular pathology.
Interpretation: The use of uJVP does not bring substantial additional clinical information to guide decision making or management in the emergency department of patients potentially suffering from congestive heart failure.
JC Supervisor: Dr. Debra Eagles