title: Effects of the Trendelenburg Position and Positive End-Expiratory Pressure on the Internal Jugular Vein Cross-Sectional Area in Children With Simple Congenital Heart Defects.
abstract: Catheterization of the internal jugular vein (IJV) remains difficult in pediatric populations. Increasing the cross-sectional area (CSA) of the IJV facilitates cannulation and decreases complications. We aimed to evaluate the Trendelenburg position and the levels of positive end-expiratory pressure (PEEP) at which the maximum increase of CSA of the IJV occurred in children undergoing cardiac surgery.In this prospective study, the CSA of the right IJV was assessed using ultrasound in 47 anesthetized pediatric patients with simple congenital heart defects. The baseline CSA was obtained in response to a supine position with no PEEP and compared with 5 different randomly ordered maneuvers, that is, a PEEP of 5 and 10 cm H2O in a supine position and of 0, 5, and 10 cm H2O in a 10° Trendelenburg position. Hemodynamic variables, including blood pressure and heart rate, maximum and minimum diameters, and CSA, were measured.All maneuvers increased the CSA of the right IJV with respect to the control condition. In the supine position, the CSA was increased by 9.4% with a PEEP of 5 and by 19.5% with a PEEP of 10 cm H2O. The Trendelenburg tilt alone increased the CSA by 19.0%, and combining the 10° Trendelenburg with a 10 cm H2O PEEP resulted in the largest IJV CSA increase (33.3%) compared with the supine position with no PEEP. Meanwhile, vital signs remained relatively steady during the experiment.The application of the Trendelenburg position and a 10 cm H2O PEEP thus significantly increases the CSA of the right IJV, perhaps improving the chances of successful cannulation in pediatric patients with simple congenital heart defects.
authors.affiliation: From the Department of Anesthesiology and Pain Medicine (HYK), Hangang Sacred Heart Hospital, Hallym University College of Medicine; and Department of Anesthesiology and Pain Medicine (JMC, Y-HL, SL, HY, MG), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Hee Yeong
authors.initials: HY
authors.lastname: Kim
authors.forename: Jae Moon
authors.initials: JM
authors.lastname: Choi
authors.forename: Yong-Hun
authors.initials: YH
authors.lastname: Lee
authors.forename: Sukyung
authors.initials: S
authors.lastname: Lee
authors.forename: Hwanhee
authors.initials: H
authors.lastname: Yoo
authors.forename: Mijeung
authors.initials: M
authors.lastname: Gwak
mesh_terms: D001794:Blood Pressure; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods; D005260:Female; D018475:Head-Down Tilt / Q000502:physiology*; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D008297:Male; D056888:Patient Positioning / Q000379:methods; D011175:Positive-Pressure Respiration / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods