title: Usefulness of the external jugular vein examination in detecting abnormal central venous pressure in critically ill patients.
abstract: BACKGROUND
  Central venous pressure (CVP) provides important information for the management of critically ill patients. The external jugular vein (EJV) is easier to visualize than the internal jugular vein and may give a reliable estimate of CVP.
  
  
  METHODS
  To determine the usefulness of the EJV examination in detecting abnormal CVP values, we performed a prospective blinded evaluation comparing it with CVP measured using an indwelling catheter in critically ill patients with central venous catheters. Blinded EJV examinations were performed by clinicians with 3 experience levels (attending physicians, residents and fellows, and interns and fourth-year medical students) to estimate CVP (categorized as low [</=5 cm of water] or high [>/=10 cm of water]). The usefulness of the EJV examination in discriminating low vs high CVP was measured using receiver operating characteristic curve analysis.
  
  
  RESULTS
  One hundred eighteen observations were recorded among 35 patients. The range of CVP values was 2 to 20 cm of water. The EJV was easier to visualize than the internal jugular vein (mean visual analog scale score, 8 vs 5; P<.001). The reliability for determining low and high CVP was excellent, with areas under the curve of 0.95 (95% confidence interval [CI], 0.88-1.00) and 0.97 (95% CI, 0.92-1.00), respectively, for attending physicians and 0.86 (95% CI, 0.78-0.95) and 0.90 (95% CI, 0.84-0.96), respectively, for all examiners.
  
  
  CONCLUSIONS
  The EJV examination correlates well with catheter-measured CVP and is a reliable means of identifying low and high CVP values.
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Department of Medicine, The University of Chicago, Chicago, Ill, USA.
authors.forename: Ajeet G
authors.initials: AG
authors.lastname: Vinayak
authors.forename: Joseph
authors.initials: J
authors.lastname: Levitt
authors.forename: Brian
authors.initials: B
authors.lastname: Gehlbach
authors.forename: Anne S
authors.initials: AS
authors.lastname: Pohlman
authors.forename: Jesse B
authors.initials: JB
authors.lastname: Hall
authors.forename: John P
authors.initials: JP
authors.lastname: Kress
mesh_terms: D000368:Aged; D001795:Blood Pressure Determination; D002405:Catheterization, Central Venous; D002496:Central Venous Pressure / Q000502:physiology*; D016001:Confidence Intervals; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007601:Jugular Veins / Q000502:physiology*; D008297:Male; D008503:Medical Staff; D008875:Middle Aged; D010808:Physical Examination; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve