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Anesthesia & Analgesia:
doi: 10.1213/ANE.0000000000000347
Patient Safety: Brief Report

Positive End-Expiratory Pressure to Increase Internal Jugular Vein Size Is Poorly Tolerated in Obese Anesthetized Adults

Downey, Laura A. MD; Blaine, Kevin P. MD, MPH; Sliwa, Jan MD; Macario, Alex MD, MBA; Brock-Utne, John MD, PhD

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Abstract

BACKGROUND: Central venous cannulation is technically challenging in obese patients. We hypothesized that positive end-expiratory pressure (PEEP) increases the size of the internal jugular vein (IJV) in obese adults.

METHODS: The circumference and cross-sectional area of the IJV were measured in obese patients under general anesthesia at PEEP 0, 5, and 10 cm H2O. Results are reported as means ± SE.

RESULTS: PEEP at 10 cm H2O was tolerated by 18 of 24 obese patients. Each 5 cm H2O of PEEP increased the cross-sectional area by 0.16 ± 0.02 cm2 (P < 0.0001) and the circumference by 0.23 ± 0.03 cm (P < 0.0001).

CONCLUSIONS: PEEP modestly increases the size of the IJV in obese adults but was poorly tolerated because of hypotension.

© 2014 International Anesthesia Research Society

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