Bedside Ultrasound for Fluid Estimation

Study Overview
=================
Brief Summary
-----------------
The study aims to standardize patient positioning during bedside ultrasound assessment of internal jugular vein (IJV) and correlate the results with invasive hemodynamics obtained immediately after. The study hypothesizes that the respiratory variation in the size of IJV, as estimated through ultrasound at bedside, is an accurate estimation of the patient's actual right atrial pressure estimated through right heart catheterization.

Official Title
-----------------
Correlation of Internal Jugular and Inferior Vena Cava Diameter Variation on Bedside Ultrasound With Invasive Right Heart Catheterization

Conditions
-----------------
Catheterization

Intervention / Treatment
-----------------
* Device: Ultrasound imaging


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Undergoing right heart catheterization Exclusion Criteria: Superior vena cava obstruction or compression Severe tricuspid regurgitation Mechanically ventilated patients

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 99 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Right heart catheterization<br> | Device: Ultrasound imaging<br>* Patients scheduled to undergo right heart catheterization (RHC) as their standard of care will be included in the study. The patient will be positioned supine at 0 degrees with normal restful breathing and patient looking straight up. After the right sternocleidomastoid muscle is identified, internal jugular vein (IJV) will be imaged at the apex of the triangle formed by the sternal and clavicular heads of the muscle. Similarly, the inferior vena cava (IVC) will be imaged at the caudal end of the sternum. The diameters of both the veins will be noted during normal respiration. The patients will then be asked to sniff and collapsibility of the veins will be noted. No pressure will be applied on the neck. The anticipated duration for image acquisition is between 5 to 10 minutes. The patients will undergo the scheduled RHC within 1 hour as scheduled.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cross-sectional diameters of the internal jugular vein (IJV) | The respiratory variation percentage will assessed using M-mode of the ultrasound while the patient is breathing normally. The maximum and minimum anteroposterior diameter will be noted using M-mode (in mm). | 5 minutes | 
| Cross-sectional diameters of the internal jugular vein (IJV) | Diameter variation index will be calculated as: (maximum diameter - minimum diameter)/ body surface area. | 5 minutes | 
| Sniff collapsibility of IJV | Complete collapse (0cm) of the anteroposterior diameter of IJV on sniff maneuver by the patient, as assessed by M-mode on the ultrasound. | 10 minutes | 
| Cross-sectional diameters of the inferior vena cava (IVC) | Maximum diameter - noted using M-mode (in mm) of the ultrasound machine. | 5 minutes | 
| Cross-sectional diameters of the inferior vena cava (IVC) | Respiratory variation - assessed using M-mode of the ultrasound while the patient is breathing normally. This will be calculated as (maximum diameter - minimum diameter)/maximum diameter and expressed as a percentage. The maximum and minimum diameters will be noted using M-mode (in mm). | 5 minutes | 
| Cross-sectional diameters of the inferior vena cava (IVC) | Sniff collapsibility - Complete collapse (0cm) of the cross sectional diameter of IVC on sniff maneuver by the patient, as assessed by M-mode of the ultrasound. | 5 minutes | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Internal jugular vein, Inferior vena cava, Right heart catheterization