Measurement of Internal Jugular Vein Distensibility Index by Ultrasound as Alternative of Echocardiography for Prediction of Fluid Responsiveness in Postpartum Preeclamptic Patients

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Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt

Abstract

Background: No evidence existed examining the role of the internal jugular vein distensibility index as a dynamic predictor of fluid responsiveness in preeclamptic patients during the postpartum period. Aim: To discuss the predictive ability of the internal jugular vein distensibility index for identifying fluid responsiveness in preeclamptic patients during the postpartum period. Methods: This study was conducted on 66 postpartum preeclamptic patients. The primary outcome included changes in cardiac index and internal jugular vein distensibility index in response to fluid administration. Secondary outcomes included the severity of preeclampsia and diagnostic accuracy of the internal jugular vein distensibility index to detect fluid responsiveness. A fluid challenge with 7 ml/kg of Ringer’s lactate was administered over 15 minutes, and patients were classified as fluid responders or non-responders. For responders, the fluid challenge and measurements were repeated until they transitioned to non-responder status. Results: This study demonstrated a statistically significant positive correlation between ∆ cardiac index and internal jugular vein distensibility index at the first and second challenges (r = 0.802, P = 0.001 and r = 0.632, P = 0.03), respectively. Nevertheless, no significant correlation was found at the third and fourth challenges. Internal jugular vein distensibility index at a cutoff value of 17% had a sensitivity of 88% and specificity of 78% (AUC= 0.852, P= 0.001). Conclusion: Measurement of the internal jugular vein distensibility index can serve as a simple and efficient bedside test for promptly and non-invasively diagnosing and monitoring volume responsiveness in preeclamptic patients postpartum.

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