The effect of passive leg raising maneuver on right internal jugular
vein diameter in ICU patients under mechanical ventilation
Presented by : Mansoor Masjedi ; MD
Assisstant professor of anesthesia & critical care consultant
Shiraz university of medical sciences , Iran
Milan , Italy - October , 2016

INTRODUCTION
 To improve accessibility, central vein catheterization in upper body region
classically done in trendelenburg position but it may impose potential
disadvantages to respiratory system and disturb physiologic status of many other
organs.
 Passive leg raising (PLR), a simple maneuver , widely used to improve cardiac
preload and to predict patients' volume responsiveness could be an alternative.
The effect of passive leg raising maneuver on right internal jugular
vein diameter in ICU patients under mechanical ventilation

OBJECTIVES
In this study,
we evaluated the effect of PLR maneuver
on right internal jugular vein (RIJV) diameter
in intensive care unit patients
under mechanical ventilation
The effect of passive leg raising maneuver on right internal jugular
vein diameter in ICU patients under mechanical ventilation

METHODS
 As a prospective study , 20 pts under synchronized intermittent mandatory
ventilation (SIMV) without valvular heart dis. or heart failure and acute respiratory
distress syndrome or inotrope infusion , were studied.
 Measurements were at the end of inspiratory cycle with positive end expiratory
pressure of 5 cmH2o.
 We chose 30° PLR to keep bedridden patients away from
possible damage that may be induced with higher upward slope
The effect of passive leg raising maneuver on right internal jugular
vein diameter in ICU patients under mechanical ventilation

METHODS
RIJV diameter was measured with
bedside color Doppler sonography of neck ,
at the level of cricoid cartilage ,
with least pressure of probe on neck ,
largest AP diameter plus surface area ,
1st in supine position and then for 2nd & 3rd measurements ,
after 30° PLR for 1 and 10 minutes ,
4th measurement ; 5 min. after return to pre-test position
1 2 3 4

RESULTS
 RIJV diameter increased with 30° PLR maneuver more prominent after 1 min. in comparison
to 10 th min. time point.
 Mean RIJV diameter was 11.66mm in supine, 13.37mm (P=0.001)
and 12.95mm (P=0.005), 1 and 10 minutes after 30° PLR maneuver
respectively .
 Increments in diameter were slightly lower than that associated with trendelenburg position
reported in previous studies .
 No complication was noted.
The effect of passive leg raising maneuver on right internal jugular
vein diameter in ICU patients under mechanical ventilation
means 10 min

CONCLUSION
PLR maneuver can be safely considered
as an alternative to trendelenberg position
to increase internal jugular vein diameter
in mechanically ventilated patients
The effect of passive leg raising maneuver on right internal jugular
vein diameter in ICU patients under mechanical ventilation

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