Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942001000600006
Brazilian Journal of Anesthesiology
Scientific Article

A articulação acrômio-clavicular como ponto de referência alternativo para o nível flebostático

Acromion-clavicular joint as an alternative reference point for the phlebostatic level

Getúlio Rodrigues de Oliveira Filho; Rolando Eliezer Jimenez Bernal; Sandro Luiz Pivatto; Alexandre Teobaldo Tomasi; Luiz Fernando Soares; Pablo Escovedo Helayel

http://dx.doi.org/10.1590/S0034-70942001000600006 Braz J Anesthesiol, vol.51, n6, p.511-517, 2001
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Resumo

JUSTIFICATIVA E OBJETIVOS: O nível flebostático corresponde ao ponto médio do diâmetro ântero-posterior do tórax, ao nível do 4º espaço intercostal e constitui-se no ponto de referência padrão para o nível zero da pressão venosa central. Freqüentemente, durante anestesia, o acesso à face lateral do tórax é impossível. Este estudo teve por objetivo, derivar uma equação que possibilite a estimativa do nível flebostático a partir de variáveis antropométricas e da altura da articulação acrômio-clavicular. MÉTODO: Foram estudados 200 pacientes. O grupo 1 foi utilizado para derivação da equação e o grupo 2, para sua validação. Foram coletados dados antropométricos. O nível flebostático e a altura da articulação acrômio-clavicular foram medidos em decúbito dorsal. Regressão linear múltipla foi utilizada no grupo 1, tendo como variável dependente o nível flebostático, e independentes, as variáveis antropométricas e a altura da articulação acrômio-clavicular. No grupo 2, a concordância entre os valores do eixo flebostático observados e preditos pela equação foi testada pelo método de Bland-Altman. RESULTADOS: A equação resultante do grupo 1 foi: nível flebostático = 49,57 + (0,19 x Idade) + (0,31 x Peso) + (0,20 x altura da articulação acrômio-clavicular). A diferença média entre os valores preditos e observados do nível flebostático, no grupo 2 foi de 2,79 ± 7,62 mm. CONCLUSÕES: A equação apresentada neste estudo pode prever com precisão o ponto flebostático.

Palavras-chave

MONITORIZAÇÃO, MONITORIZAÇÃO

Abstract

BACKGROUNDS AND OBJECTIVES: The phlebostatic level corresponds to the medium point of the anterior-posterior thoracic diameter at the level of the 4th intercostal space. It is the standard reference point for central venous pressure zero level. In general, the access to the lateral aspect of the thorax is impossible during anesthesia. This study aimed at building an equation to estimate the phlebostatic level based on anthropometric variables and the acromion-clavicular joint level. METHODS: Participated in this prospective study 200 patients who were distributed in two groups. Group 1 was used for building the predictive equation. Group 2 was used for the validation of its predictive capability. Anthropometric data were collected. Phlebostatic level and acromion-clavicular joint height were measured in the supine position. Multiple linear regression was used in Group 1, with phlebostatic level as the dependent variable, and anthropometric variables, as well as acromion-clavicular joint height, as independent variables. Bland-Altman method was used in Group 2 to test the agreement between the observed and estimated phlebostatic level values. RESULTS: Group 1 resulting equation was: phlebostatic level = 49.57 + (0.19 x age) + (0.31 x weight) + (0.20 x acromion-clavicular joint height). Mean difference in Group 2 between estimated and observed phlebostatic levels was 2.79 ± 7.62 mm. CONCLUSIONS: The equation presented in this study can accurately predict the phlebostatic level.

Keywords

MONITORING, MONITORING

References

Knopp R, Dailey RH. Central venous cannulation and pressure monitoring. JACEP. 1977;6:358-366.

Courtois M, Fattal PG, Kovacs SJ. Anatomically and physiologically based reference level for measurement of intracardiac pressures. Circulation. 1995;92:1994-2000.

Kee LL, Simonson JS, Stotts NA. Echocardiographic determination of valid reference levels in supine and lateral positions. Am J Crit Care. 1993;2:72-80.

Groom L, Frisch SR, Elliott M. Reproducibility and accuracy of pulmonary artery pressure measurement in supine and lateral positions. Heart Lung. 1990;19:147-151.

Potger KC, Elliott D. Reproducibility of central venous pressures in supine and lateral positions: a pilot evaluation of the phlebostatic axis in critically ill patients. Heart Lung. 1994;23:285-299.

Haywood GA, Joy MD, Camm AJ. Influence of posture and reference point on central venous pressure measurement. BMJ. 1991;303:626-627.

McGee SR. Physical examination of venous pressure: a critical review. Am Heart J. 1998;136:10-18.

Knell PJ. Central venous pressure measurement: A device for continuously indicating zero. Anaesthesia. 1980;35:991-992.

Pedersen A, Husby J. Venous pressure measurement: I. Choice of the zero level. Acta Med Scand. 1951;141:185-194.

Debrunner F, Bühler F. Normal central venous pressure: significance of reference point and normal range. Br Med J. 1969;3:148-150.

Everitt BS. Statistical Methods in Medical Investigations. 1994:2-3.

Glantz AS. Primer of Biostatistics. 1997:266-271.

Bland JM, Altman DG. Statistical methods for assessing agreement between two measures of clinical measurement. Lancet. 1986;1:307-310.

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