Thank you for inviting a response to the letter from Dr Jolobe concerning our article.
1
We share his concern that some of our colleagues and trainees have become cynical about the usefulness of jugular venous pressure assessment in the current era of acute medicine. Junior doctors may be more likely to rely on tests (formal echocardiogram, chest X-ray, natriuretic peptide level) or response to diuresis prior to diagnosing congestive heart failure. This means the diagnosis may be incorrect or delayed. Why has it come to this? There are several reasons:
- 1.The assessment of jugular venous pressure has been badly taught.1
- 2.Central venous pressure is dynamic and changes rapidly in response to changes in blood volume and its distribution. Jugular venous pressure level seen in the emergency department by the registrar may be quite different to what the consultant sees the next morning.
- 3.Even with the best technique, the jugular venous pressure wave form is not visible in about 20% of patients.2This is usually due to the shape of the neck or respiratory movement.
Despite these problems, the use of bedside echocardiogram to assess inferior vena caval dimensions has already been shown to validate jugular venous pressure measurements in the acute setting.
3
Eventually, bedside echocardiogram will become more routinely available in these patients, but in the meantime, we must ensure that our jugular venous pressure assessment is as good as it can be.References
- Measuring jugular venous pressure: do not turn the head!.Am J Med. 2022; 135: P552-P554
- Physical examination of venous pressure: a critical review.Am Heart J. 1998; 136: 10-18
- Comparison of estimates of right atrial pressure by physical examination and echocardiography in patients with congestive heart failure and reasons for discrepancies.Am J Cardiol. 1997; 80: 1615-1618
Article Info
Footnotes
Funding: None.
Conflicts of Interest: None.
Authorship: The sole author is responsible for all content.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
