title: The impact of Trendelenburg position and positive end-expiratory pressure on the internal jugular cross-sectional area.
abstract: BACKGROUND
  Increasing the cross-sectional area (CSA) of the right internal jugular vein facilitates cannulation and decreases complications. Maneuvers such as the Trendelenburg tilt position and ventilation with a positive end-expiratory pressure (PEEP) may increase the CSA of the right internal jugular vein. We determined the changes in the CSA in response to different maneuvers.
  
  
  METHODS
  The CSA (cm(2)) of the right internal jugular vein was assessed in 50 anesthetized adult cardiothoracic surgery patients using 2-dimensional ultrasound. First, the CSA was measured in response to supine position with no PEEP (control condition, S0) and compared with 5 different randomly ordered maneuvers: (1) PEEP ventilation with 5 cm H(2)O (S5), (2) PEEP with 10 cm H(2)O (S10), (3) a 20 degrees Trendelenburg tilt position with a PEEP of 0 cm H(2)O (T0), (4) a 20 degrees Trendelenburg tilt position combined with a PEEP of 5 cm H(2)O (T5), and (5) a 20 degrees Trendelenburg tilt position combined with a PEEP of 10 cm H(2)O (T10).
  
  
  RESULTS
  All maneuvers increased the CSA of the right internal jugular vein with respect to the control condition S0 (all P < 0.05). S5 increased the CSA on average by 15.9%, S10 by 22.3%, T0 by 39.4%, T5 by 38.7%, and T10 by 49.7%.
  
  
  CONCLUSIONS
  In a comparison of the effectiveness of applying different PEEP levels and/or the Trendelenburg tilt position on the CSA of the right internal jugular vein, the Trendelenburg tilt position was most effective.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany. hanke.marcus@uk-koeln.d
authors.forename: Hanke E
authors.initials: HE
authors.lastname: Marcus
authors.forename: Egfried
authors.initials: E
authors.lastname: Bonkat
authors.forename: Oguzhan
authors.initials: O
authors.lastname: Dagtekin
authors.forename: Robert
authors.initials: R
authors.lastname: Schier
authors.forename: Frank
authors.initials: F
authors.lastname: Petzke
authors.forename: Jens
authors.initials: J
authors.lastname: Wippermann
authors.forename: Bernd W
authors.initials: BW
authors.lastname: Böttiger
authors.forename: Peter
authors.initials: P
authors.lastname: Teschendorf
mesh_terms: D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous; D001026:Coronary Artery Bypass; D018475:Head-Down Tilt; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007601:Jugular Veins / Q000648:ultrastructure*; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D013510:Pulmonary Surgical Procedures; D016683:Supine Position