Friday, November 12, 2021

POCUS and the JVP

POCUS Med Ed - By Istrail - November 12, 2021
I've spent the last year scanning hundreds of jugular veins and writing a book on point of care ultrasound. It has resulted in this preprint study on a novel method for estimating jugular pressure and right atrial pressure, and a book. The following is a more in-depth, technical deep dive into the internal jugular vein exam expanded from Chapters 14 and 15 of The POCUS Manifesto: Expanding the limits of the physical exam with point-of-care ultrasound…
Concluding Thoughts
This study has been submitted for publication but has yet to be peer reviewed. Overall I found that this method can very accurately estimate right atrial pressure within a couple of millimeters of mercury almost every time. A major limitation of our initial study was the fact that we compared our estimate to a right atrial pressure measured by many different cardiologists with no standard zero-level amongst them. This made it very difficult - or impossible - to say exactly how close our measurements actually were to the actual right atrial pressure. This technique measures the right atrial depth in every patient, which can vary from 5cm to 15cm. Therefore it is not clear if using a right heart cath - which uses a standard measurement on every patient - is even a good comparison to use. We have controlled for these issues and are currently underway with a follow-up study.”