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Ajeet G. Vinayak, MD; Joseph Levitt, MD; Brian Gehlbach, MD; Anne S. Pohlman, MSN; Jesse B. Hall, MD; John P. Kress, MD

Arch Intern Med. 2006;166:2132-2137.

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.

Conclusion  The EJV examination correlates well with catheter-measured CVP and is a reliable means of identifying low and high CVP values.

Trial Registration  clinicaltrials.gov Identifier: NCT00303355

Author Affiliations: Section of Pulmonary and Critical Care Medicine, Department of Medicine, The University of Chicago, Chicago, Ill. Dr Vinayak is now with the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Virginia, Charlottesville, and Dr Levitt is now with the Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, Calif.