title: [Ultrasound-guided central venous cannulation in neuropaediatric patients to avoid measures causing potential increase in brain pressure].
abstract: BACKGROUND
  Certain measures such as the Trendelenburg position or an increase in intrathoracic pressure raise the chances for a successful puncture of the internal jugular vein (IJV) particularly in paediatric patients. However, these measures are contraindicated in patients with increased intracranial pressure. Therefore, in anaesthetised and ventilated neuropaediatric patients we investigated whether ultrasound-guided cannulation of the IJV can replace these measures.
  
  
  METHODS
  In this prospective study,8 newborns, 46 infants and 66 small children were included. The cross-sectional area of the right IJV was sonographically measured in horizontal and 15 degrees Trendelenburg positions with or without PEEP 0, 5 or 10 cm H(2)O. The IJV was then punctured at the conditions of a predetermined position and PEEP combination under sonographic guidance (5-8 MHz).
  
  
  RESULTS
  The mean cross-sectional area of the IJV was 0.3-1.6 cm(2) in the horizontal position without PEEP ( n=120) and was enlarged due to the Trendelenburg position by 24% and by 63%, when PEEP 10 cm H(2)O was added. Independent of positioning and PEEP the ultrasound-guided puncture was successful at the first attempt in 98% of cases and a second attempt had to be made in only two children.
  
  
  CONCLUSIONS
  Under sonographic visualisation of the cross-sectional area, the IJV can easily and safely be punctured for central venous cannulation in newborn, infants and small children without measures such as the Trendelenburg position or implementation of PEEP.
authors.affiliation: Klinik für Anaesthesiologie, Universitätsklinikum Würzburg,Würzburg. htrautner@gmx.de
authors.forename: H
authors.initials: H
authors.lastname: Trautner
authors.forename: C-A
authors.initials: CA
authors.lastname: Greim
authors.forename: H
authors.initials: H
authors.lastname: Arzet
authors.forename: U
authors.initials: U
authors.lastname: Schwemmer
authors.forename: N
authors.initials: N
authors.lastname: Roewer
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019586:Intracranial Hypertension / Q000517:prevention & control*; D007601:Jugular Veins / Q000000981:diagnostic imaging; D008297:Male; D019635:Neurosurgical Procedures; D011175:Positive-Pressure Respiration; D011187:Posture; D011446:Prospective Studies; D014465:Ultrasonics; D014463:Ultrasonography