Journal of Anesthesia

, Volume 32, Issue 3, pp 316–325 | Cite as

Positive end-expiratory pressure-induced increase in external jugular venous pressure does not predict fluid responsiveness in laparoscopic prostatectomy

  • Min Hur
  • Seokha Yoo
  • Jung-Yoon Choi
  • Sun-Kyung Park
  • Dhong Eun Jung
  • Won Ho Kim
  • Jin-Tae Kim
  • Jae-Hyon Bahk
Original Article



Dynamic change in central venous pressure (CVP) was associated with fluid responsiveness. External jugular venous pressure (EJVP) may reliably estimate CVP and have the advantages of being less invasive. We investigated whether increase in EJVP induced by positive end-expiratory pressure (PEEP) could be a reliable predictor of fluid responsiveness in patients undergoing robot-assisted laparoscopic prostatectomy (RALP).


Fifty patients who underwent RALP with steep Trendelenburg position were enrolled. PEEP of 10 cmH2O was applied for 5 min and then 300 ml of colloid was administered. EJVP, stroke volume variation (SVV), and cardiac index calculated by pulse contour method were measured before and after the PEEP challenge and colloid administration. Increase in cardiac index > 10% was used to define the fluid responsiveness.


Twenty-six patients were fluid responders. Neither the increase in EJVP after the initial PEEP nor SVV was significantly different between responders and non-responders. They were not significantly correlated with an increase in cardiac index. The areas under the receiver operating characteristic curve (AUC) of these two variables were not significantly greater than 0.5. However, a post hoc analysis revealed that AUC of a decrease in EJVP after removal of PEEP was significantly greater than 0.50.


Our study results suggested that SVV and increase in EJVP after applying PEEP were not accurate predictors of fluid responsiveness during RALP. Further studies are required to find an adequate preload index in robot-assisted urologic surgery with steep Trendelenburg position.


Laparoscopy Robot surgery Cardiac output Central venous pressure Fluid responsiveness 



This study did not receive any external fund.

Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest.

Supplementary material

540_2018_2475_MOESM1_ESM.pdf (200 kb)
Supplementary material 1 (PDF 200 kb)


  1. 1.
    Monk TG, Saini V, Weldon BC, Sigl JC. Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg. 2005;100:4–10.CrossRefPubMedGoogle Scholar
  2. 2.
    Walsh M, Devereaux PJ, Garg AX, Kurz A, Turan A, Rodseth RN, Cywinski J, Thabane L, Sessler DI. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension. Anesthesiology. 2013;119:507–15.CrossRefPubMedGoogle Scholar
  3. 3.
    Cannesson M, Musard H, Desebbe O, Boucau C, Simon R, Henaine R, Lehot JJ. The ability of stroke volume variations obtained with Vigileo/FloTrac system to monitor fluid responsiveness in mechanically ventilated patients. Anesth Analg. 2009;108:513–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Biais M, Bernard O, Ha JC, Degryse C, Sztark F. Abilities of pulse pressure variations and stroke volume variations to predict fluid responsiveness in prone position during scoliosis surgery. Br J Anaesth. 2010;104:407–13.CrossRefPubMedGoogle Scholar
  5. 5.
    Rex S, Brose S, Metzelder S, Huneke R, Schalte G, Autschbach R, Rossaint R, Buhre W. Prediction of fluid responsiveness in patients during cardiac surgery. Br J Anaesth. 2004;93:782–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Lestar M, Gunnarsson L, Lagerstrand L, Wiklund P, Odeberg-Wernerman S. Hemodynamic perturbations during robot-assisted laparoscopic radical prostatectomy in 45 degrees Trendelenburg position. Anesth Analg. 2011;113:1069–75.CrossRefPubMedGoogle Scholar
  7. 7.
    Meininger D, Westphal K, Bremerich DH, Runkel H, Probst M, Zwissler B, Byhahn C. Effects of posture and prolonged pneumoperitoneum on hemodynamic parameters during laparoscopy. World J Surg. 2008;32:1400–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Kalmar AF, Dewaele F, Foubert L, Hendrickx JF, Heeremans EH, Struys MM, Absalom A. Cerebral haemodynamic physiology during steep Trendelenburg position and CO(2) pneumoperitoneum. Br J Anaesth. 2012;108:478–84.CrossRefPubMedGoogle Scholar
  9. 9.
    Schramm P, Treiber AH, Berres M, Pestel G, Engelhard K, Werner C, Closhen D. Time course of cerebrovascular autoregulation during extreme Trendelenburg position for robotic-assisted prostatic surgery. Anaesthesia. 2014;69:58–63.CrossRefPubMedGoogle Scholar
  10. 10.
    Chin JH, Lee EH, Hwang GS, Choi WJ. Prediction of fluid responsiveness using dynamic preload indices in patients undergoing robot-assisted surgery with pneumoperitoneum in the Trendelenburg position. Anaesth Intensive Care. 2013;41:515–22.PubMedGoogle Scholar
  11. 11.
    Wajima Z, Shiga T, Imanaga K. Pneumoperitoneum affects stroke volume variation in humans. J Anesth. 2015;29:508–14.CrossRefPubMedGoogle Scholar
  12. 12.
    Chin JH, Kim WJ, Choi JH, Han YA, Kim SO, Choi WJ. Unreliable tracking ability of the third-generation FloTrac/Vigileo system for changes in stroke volume after fluid administration in patients with high systemic vascular resistance during laparoscopic surgery. PLoS One. 2015;10:e0142125.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    De Backer D, Taccone FS, Holsten R, Ibrahimi F, Vincent JL. Influence of respiratory rate on stroke volume variation in mechanically ventilated patients. Anesthesiology. 2009;110:1092–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Reuter DA, Bayerlein J, Goepfert MS, Weis FC, Kilger E, Lamm P, Goetz AE. Influence of tidal volume on left ventricular stroke volume variation measured by pulse contour analysis in mechanically ventilated patients. Intensive Care Med. 2003;29:476–80.CrossRefPubMedGoogle Scholar
  15. 15.
    Kawazoe Y, Nakashima T, Iseri T, Yonetani C, Ueda K, Fujimoto Y, Kato S. The impact of inspiratory pressure on stroke volume variation and the evaluation of indexing stroke volume variation to inspiratory pressure under various preload conditions in experimental animals. J Anesth. 2015;29:515–21.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008;134:172–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Cherpanath TG, Geerts BF, Maas JJ, de Wilde RB, Groeneveld AB, Jansen JR. Ventilator-induced central venous pressure variation can predict fluid responsiveness in post-operative cardiac surgery patients. Acta Anaesthesiol Scand. 2016;60:1395–403.CrossRefPubMedGoogle Scholar
  18. 18.
    Geerts BF, Aarts LP, Groeneveld AB, Jansen JR. Predicting cardiac output responses to passive leg raising by a PEEP-induced increase in central venous pressure, in cardiac surgery patients. Br J Anaesth. 2011;107:150–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Magder S, Lagonidis D, Erice F. The use of respiratory variations in right atrial pressure to predict the cardiac output response to PEEP. J Crit Care. 2001;16:108–14.CrossRefPubMedGoogle Scholar
  20. 20.
    Parker JL, Flucker CJ, Harvey N, Maguire AM, Russell WC, Thompson JP. Comparison of external jugular and central venous pressures in mechanically ventilated patient. Anaesthesia. 2002;57:596–600.CrossRefPubMedGoogle Scholar
  21. 21.
    Leonard AD, Allsager CM, Parker JL, Swami A, Thompson JP. Comparison of central venous and external jugular venous pressures during repair of proximal femoral fracture. Br J Anaesth. 2008;101:166–70.CrossRefPubMedGoogle Scholar
  22. 22.
    Kim N, Shim JK, Choi HG, Kim MK, Kim JY, Kwak YL. Comparison of positive end-expiratory pressure-induced increase in central venous pressure and passive leg raising to predict fluid responsiveness in patients with atrial fibrillation. Br J Anaesth. 2016;116:350–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Cecconi M, Parsons AK, Rhodes A. What is a fluid challenge? Curr Opin Crit Care. 2011;17:290–5.CrossRefPubMedGoogle Scholar
  24. 24.
    Marik PE, Cavallazzi R, Vasu T, Hirani A. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009;37:2642–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Hoiseth LO, Hoff IE, Myre K, Landsverk SA, Kirkeboen KA. Dynamic variables of fluid responsiveness during pneumoperitoneum and laparoscopic surgery. Acta Anaesthesiol Scand. 2012;56:777–86.CrossRefPubMedGoogle Scholar
  26. 26.
    Seo H, Kong YG, Jin SJ, Chin JH, Kim HY, Lee YK, Hwang JH, Kim YK. Dynamic arterial elastance in predicting arterial pressure increase after fluid challenge during robot-assisted laparoscopic prostatectomy: a prospective observational study. Medicine (Baltimore). 2015;94:e1794.CrossRefGoogle Scholar
  27. 27.
    Phong SV, Koh LK. Anaesthesia for robotic-assisted radical prostatectomy: considerations for laparoscopy in the Trendelenburg position. Anaesth Intensive Care. 2007;35:281–5.PubMedGoogle Scholar
  28. 28.
    Rosendal C, Markin S, Hien MD, Motsch J, Roggenbach J. Cardiac and hemodynamic consequences during capnoperitoneum and steep Trendelenburg positioning: lessons learned from robot-assisted laparoscopic prostatectomy. J Clin Anesth. 2014;26:383–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Mesquida J, Kim HK, Pinsky MR. Effect of tidal volume, intrathoracic pressure, and cardiac contractility on variations in pulse pressure, stroke volume, and intrathoracic blood volume. Intensive Care Med. 2011;37:1672–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Duperret S, Lhuillier F, Piriou V, Vivier E, Metton O, Branche P, Annat G, Bendjelid K, Viale JP. Increased intra-abdominal pressure affects respiratory variations in arterial pressure in normovolaemic and hypovolaemic mechanically ventilated healthy pigs. Intensive Care Med. 2007;33:163–71.CrossRefPubMedGoogle Scholar
  31. 31.
    Valenza F, Chevallard G, Porro GA, Gattinoni L. Static and dynamic components of esophageal and central venous pressure during intra-abdominal hypertension. Crit Care Med. 2007;35:1575–81.CrossRefPubMedGoogle Scholar
  32. 32.
    Jacques D, Bendjelid K, Duperret S, Colling J, Piriou V, Viale JP. Pulse pressure variation and stroke volume variation during increased intra-abdominal pressure: an experimental study. Crit Care. 2011;15:R33.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Atkinson TM, Giraud GD, Togioka BM, Jones DB, Cigarroa JE. Cardiovascular and ventilatory consequences of laparoscopic surgery. Circulation. 2017;135:700–10.CrossRefPubMedGoogle Scholar
  34. 34.
    Nanas S, Magder S. Adaptations of the peripheral circulation to PEEP. Am Rev Respir Dis. 1992;146:688–93.CrossRefPubMedGoogle Scholar
  35. 35.
    Magder S. Bench-to-bedside review: an approach to hemodynamic monitoring–Guyton at the bedside. Crit Care. 2012;16:236.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Shojaee M, Sabzghabaei A, Alimohammadi H, Derakhshanfar H, Amini A, Esmailzadeh B. Effect of positive end-expiratory pressure on central venous pressure in patients under mechanical ventilation. Emerg (Tehran). 2017;5:e1.Google Scholar
  37. 37.
    McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med. 2003;348:1123–33.CrossRefPubMedGoogle Scholar
  38. 38.
    Metzelder S, Coburn M, Fries M, Reinges M, Reich S, Rossaint R, Marx G, Rex S. Performance of cardiac output measurement derived from arterial pressure waveform analysis in patients requiring high-dose vasopressor therapy. Br J Anaesth. 2011;106:776–84.CrossRefPubMedGoogle Scholar
  39. 39.
    Slagt C, Malagon I, Groeneveld AB. Systematic review of uncalibrated arterial pressure waveform analysis to determine cardiac output and stroke volume variation. Br J Anaesth. 2014;112:626–37.CrossRefPubMedGoogle Scholar
  40. 40.
    Maddali MM, Waje ND, Sathiya PM. Authentication of radial versus femoral arterial pressure waveform-derived cardiac output with transesophageal echocardiography-derived cardiac output measurements in patients undergoing on-pump coronary bypass surgery. J Cardiothorac Vasc Anesth. 2017;31:1183–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Lamia B, Kim HK, Severyn DA, Pinsky MR. Cross-comparisons of trending accuracies of continuous cardiac-output measurements: pulse contour analysis, bioreactance, and pulmonary-artery catheter. J Clin Monit Comput. 2018;32:33–43.CrossRefPubMedGoogle Scholar
  42. 42.
    Ueyama H, Kiyonaka S. Predicting the need for fluid therapy-does fluid responsiveness work? J Intensive Care. 2017;5:34.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology and Pain MedicineSeoul National University HospitalSeoulRepublic of Korea

Personalised recommendations