• Laura A Downey, Kevin P Blaine, Jan Sliwa, Alex Macario, and John Brock-Utne.
• From the Department of Anesthesiology, Pain, and Perioperative Medicine, Stanford University Medical Center, Stanford, California. Laura A. Downey, MD, is currently affiliated with the Department of Anesthesia, Boston Childrens Hospital Boston, Boston, Massachusetts. Kevin P. Blaine, MD, MPH, is currently affiliated with the Critical Care Medicine Department of the National Institutes of Health Clinical Center, Bethesda, Maryland.
• Anesth. Analg.. 2014 Sep 1;119(3):619-21.

BackgroundCentral venous cannulation is technically challenging in obese patients. We hypothesized that positive end-expiratory pressure (PEEP) increases the size of the internal jugular vein (IJV) in obese adults.MethodsThe circumference and cross-sectional area of the IJV were measured in obese patients under general anesthesia at PEEP 0, 5, and 10 cm H2O. Results are reported as means ± SE.ResultsPEEP at 10 cm H2O was tolerated by 18 of 24 obese patients. Each 5 cm H2O of PEEP increased the cross-sectional area by 0.16 ± 0.02 cm (P < 0.0001) and the circumference by 0.23 ± 0.03 cm (P < 0.0001).ConclusionsPEEP modestly increases the size of the IJV in obese adults but was poorly tolerated because of hypotension.

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