• Kurato Tokunaga, Kensuke Nakamura, Ryota Inokuchi, Naoki Hayase, Rui Terada, Yuji Tomioka, Toshiyuki Ikeda, Etsuko Kobayashi, Hitoshi Okazaki, Ichiro Sakuma, Kent Doi, and Naoto Morimura.
• Department of Acute Medicine, The University of Tokyo Hospital, Tokyo, Japan.
• Shock. 2020 Dec 1; 54 (6): 717-722.

BackgroundFluid resuscitation, which is critical to counter acute hemorrhagic shock, requires prompt and accurate intravascular volume estimation for optimal fluid administration. This study aimed to evaluate whether cardiac variation of internal jugular vein (IJV), evaluated by ultrasonography, could detect hypovolemic status and predict response to fluid resuscitation.MethodsPatients undergoing autologous blood transfusion for elective surgery who were prospectively enrolled at the study blood donation center between August 2014 and January 2015. Vertical B-mode ultrasonography movies of IJV were recorded at five timepoints during blood donation: before donation, during donation, end of donation, end of fluid replacement, and after hemostasis. Cardiac variation of the IJV area and circumference were objectively measured using an automated extraction program together with blood pressure and heart rate.ResultsA total of 140 patients were screened, and data from 104 patients were included in the final analyses. Among the variables analyzed, only collapse index area and collapse index circumference could detect both intravascular volume loss and response to fluid administration.ConclusionsCardiac variation of IJV may be a reliable indicator of intravascular volume loss and response to fluid administration in hemorrhagic shock.

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