Central venous pressure (CVP) and right atrial pressure (RAP) are important parameters in the complete hemodynamic assessment of a patient. Sonographic measurement of the inferior vena cava (IVC) diameter is a non-invasive method of estimating these parameters, but there are limited data summarizing its diagnostic accuracy across multiple studies. We performed a comprehensive review of the existing literature to examine the diagnostic accuracy and clinical utility of sonographic measurement of IVC diameter as a method for assessing CVP and RAP. We performed a systematic search using PubMed of clinical studies comparing sonographic evaluation of IVC diameter and collapsibility against gold standard measurements of CVP and RAP. We included clinical studies that were performed in adults, used current imaging techniques, and were published in English. Twenty one clinical studies were identified that compared sonographic assessment of IVC diameter with CVP and RAP and met all inclusion criteria. Despite substantial heterogeneity in measurement techniques and patient populations, most studies demonstrated moderate strength correlations between measurements of IVC diameter and collapsibility and CVP or RAP, but more favorable diagnostic accuracy using pre-specified cut points. Findings were inconsistent among mechanically ventilated patients, except in the absence of positive end-expiratory pressure. Sonographic measurement of IVC diameter and collapsibility is a valid method of estimating CVP and RAP. Given the ease, safety, and availability of this non-invasive technique, broader adoption and application of this method in clinical settings is warranted.

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The efficacy of sonographic measurement of inferior vena cava diameter as an estimate of central venous pressure

AIM: To study changes produced within the inferior vena cava (IVC) during respiratory movements and identify their possible clinical implications.

METHODS: This study included 100 patients (46 women; 54 men) over 18 years of age who required an abdominal computed tomography (CT) and central venous access. IVC cross-sectional areas were measured on CT scans at three levels, suprarenal (SR), juxtarenal (JR) and infrarenal (IR), during neutral breathing and again during the Valsalva maneuver. All patients were instructed on how to perform a correct Valsalva maneuver. In order to reduce the total radiation dose in our patients, low-dose CT protocols were used in all patients. The venous blood pressure (systolic, diastolic and mean) was invasively measured at the same three levels with neutral breathing and the Valsalva maneuver during venous port implantation. From CT scans, three-dimensional models of the IVC were constructed and a collapsibility index was calculated for each patient. These data were then correlated with venous pressures and cross-sectional areas.

RESULTS: The mean patient age was 51.64 ± 12.01 years. The areas of the ellipse in neutral breathing were 394.49 ± 85.83 (SR), 380.10 ± 74.55 (JR), and 342.72 ± 49.77 mm2 (IR), and 87.46 ± 18.35 (SR), 92.64 ± 15.36 (JR) and 70.05 ± 9.64 mm2 (IR) during the Valsalva (Ps < 0.001). There was a correlation between areas in neutral breathing and in the Valsalva maneuver (P < 0.05 in all areas). Large areas decreased more than smaller areas. The collapsibility indices were 0.49 ± 0.06 (SR), 0.50 ± 0.04 (JR) and 0.50 ± 0.04 (IR), with no significant differences in any region. Reconstructed three-dimensional models showed a flattening of the IVC during Valsalva, adopting an ellipsoid cross-sectional shape. The mean pressures with neutral breathing were 9.44 ± 1.78 (SR), 9.40 ± 1.44 (JR) and 8.84 ± 1.03 mmHg (IR), and 81.08 ± 21.82 (SR), 79.88 ± 19.01 (JR) and 74.04 ± 16.56 mmHg (IR) during Valsalva (Ps < 0.001). There was a negative correlation between cross-sectional caval area and venous blood pressure, but this was not statistically significant in any of the cases. There was a significant correlation between diastolic and mean pressures measured during neutral breathing and in Valsalva.

CONCLUSION: Respiratory movements have a major influence on IVC dynamics. The increase in intracaval pressure during Valsalva results in a significant decrease in the IVC cross-sectional area.

Influence of breathing movements and Valsalva maneuver on vena caval dynamics

Comparative Toxicological Study between Exposed and Non-Exposed Farmers to Organophosphorus Pesticides

OBJECTIVE To evaluate the correlation between central venous pressure (CVP) and inferior vena cava (IVC) diameters measured by ultrasonography (Ultrasound) in critically ill patients. METHODS Intubated critically ill patients were enrolled. The CVP values were measured using a U-tube manometer and were compared to the IVC diameters and collapsibility index, which were measured by bedside Ultrasound. Patients younger than 18 years old, who were not intubated, who had an abdominal pressure greater than 12 mmHg, and/or who were admitted for trauma were excluded from the study. RESULTS Eighty three patients with a mean age of 73.6±11.2 years were enrolled. The most common diagnosis was sepsis (21 patients, 25.30%). IVC inspiration measurements were statistically significantly correlated with CVP measurements (p0.05, r: 0.1). IVC collapsibility measurements showed a negative correlation with CVP measurements (p<0.01, r: 0.68). CONCLUSIONS There is a strong correlation between CVP and IVC diameters and the collapsibility index. This is a new formula for evaluating CVP, based on our statistical analyses.

A Non-invasive Method for Assessment of Intravascular Fluid Status: Inferior Vena Cava Diameters and Collapsibility Index.

To find a correlation between inferior vena cava (IVC) diameters, IVC compressibility index (CI) and central venous pressure (CVP). Prospective observational study was done at pediatric intensive care unit (PICU) of Kalawati Saran Children’s Hospital (KSCH). Fifty children aged 5-18 y, presenting with shock were enrolled for the study. IVC diameters, CI and relevant clinical data were noted at enrollment, 30 min, 1 h, 6 h, and 12 h. Central line was placed at the time of admission. Of 50 children enrolled, 28 were boys, with a mean age of 11 y. More than 80% of cases were diagnosed as septic shock. Mean maximum and minimum IVC diameter of 8.3 ± 2 mm and 3.7 ± 1.7 mm, respectively CI 58.2 ± 7% and CVP of 5.4 ± 1.5 cm of H2O was observed at admission. CVP and IVC diameters showed a serial improvement with treatment; CI showed a serial decrease with treatment. Heart rate (HR) and systolic blood pressure (SBP) also showed a serial improvement at 12 h (p < 0.05). CVP showed a positive correlation with IVC diameter (r +0.312; p < 0.05), and a negative correlation with CI (r −0.343; p < 0.05). Effective fluid resuscitation improves IVC diameters with a decrease in CI. IVC diameter has a positive correlation to CVP and CI has a negative correlation to CVP.

The Correlation Between Inferior Vena Cava Diameter Measured by Ultrasonography and Central Venous Pressure.

Objective: We aimed to present inferior vena cava (IVC) diameter as a guiding method for detection of relationship between IVC diameter measured noninvasively with the help of ultrasonography (USG) and central venous pressure (CVP) and evaluation of patient’s intravascular volume status. Methods: Patients over the age of 18, to whom a central venous catheter was inserted to their subclavian vein or internal jugular vein were included in our study. IVC diameter measurements were recorded in millimeters following measurement by the same clinician with the help of USG both at the end-inspiratory and end-expiratory phase. CVP measurements were viewed on the monitor by means of piezoelectric transducer and recorded in mmHg. SPSS 18.0 package program was used for statistical analysis of data. Results: Forty five patients were included in the study. The patients had the diagnosis of malignancy (35.6%), sepsis (13.3%), pneumonia, asthma, chronic obstructive pulmonary disease (11.1%). 11 patients (24.4%) required mechanical ventilation while 34 (75.6%) patients had spontaneous respiration. In patients with spontaneous respiration, a significant relationship was found between IVC diameters measured by ultrasonography at the end of expiratory and inspiratory phases and measured CVP values at the same phases (for expiratory p = 0.002, for inspiratory p= 0.001). There was no statistically significant association between IVC diameters measured by ultrasonography at the end of expiration and inspiration and measured CVP values at the same phases in mechanically ventilated patients. Conclusions: IVC diameter measured by bedside ultrasonography can be used for determination of the intravascular volume status of the patients with spontaneous respiration.

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The relationship between inferior vena cava diameter measured by bedside ultrasonography and central venous pressure value.

Aim: In our study, we aimed to investigate the relationship between the mortality and acute inflammatory markers, serum - erythrocyte cholinesterase levels in patients with organophosphorus poisoning.
Material and Methods: We planned to take patients who administered to emergency department with organic phosphorus poisoning prospectively for 2 years after approval by the Ethics Committee of Cukurova University. Patients with hereditary cholinesterase deficiency, liver disorders, malnourished, anemia, using cocaine, morphine, codeine, and medications such as succinylcholine were excluded from the study. A total of 39 patients were included in the study. Standard data entry form has been created. Blood samples were taken from all of the patients included in the study for use in study after diagnosis. White blood cell (WBC) and platelet counts, fibrinogen, ferritin, C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-a), interleukin-1 (IL-1), interleukin 6 (IL-6), interleukin 10 (IL-10), erythrocyte and serum cholinesterase levels were determined from blood samples in Central Laboratory of Hospital of Balcali in Cukurova University School of Medicine. SPSS 18.0 package program was used for statistical analysis of data. The statistical significance level of all tests was p

Relationship between mortality and acute inflammatory markers, erythrocyte cholinesterase, serum cholinesterase levels in the acute organic phosphorus intoxication

Amac: Bu calismada minor kafa travmasi nedeni ile acil servise basvuran hastalarda travma sonrasi donemde ortaya cikan posttravmatik bas agrisi (PTBA) ve minor kafa travmasi arasindaki iliskinin arastirilmasi amaclandi. Gerec ve Yontem: Calismamiza prospektif olarak 01.01.2009 - 31.12.2010 tarihleri arasinda Acil Tip Klinigi"mize minor kafa travmasi ile basvuran hastalarin alinmasi planlandi. PTBA gelisen ve gelismeyen tum olgularin demografik ozellikleri, ayrintili risk faktorleri, kafa travmasi olus sekli, amnezi sureleri, ozgecmiste bas agrisi, psikiyatrik hastalik, ilac kullanma oykusu, basvuru aninda, taburcu olmadan once ve 3. ayda yapilan kontrol fizik ve norolojik muayene bulgulari, direk grafi ve BT bulgulari standart veri giris formuna kayit edildi. Agir kafa travmali, bilinc duzeyi stupor ve koma tablosunda olan hastalar, gebeler, 18 yas alti travma olgulari calismaya alinmadi. Calismada elde edilen verilerin istatistiksel analizinde SPSS 17.0 paket programi kullanildi. Tum testlerde istatistiksel onem duzeyi p < 0.05 olarak kabul edildi. Bulgular: Calismamiza alinan toplam 119 hastada en sik minor kafa travmasi nedenleri arac ici trafik kazasi (% 36.1) ve arac disi trafik kazalari (% 32.8) idi. Hastalarda sadece izole kafa travmasi sonrasi % 87, kafa + servikal travma sonrasi % 88.4, kafa + servikal + kamci ucu travmasi sonrasi ise % 93.3 oraninda PTBA gelistigi saptandi. PTBA olan hastalarda olmayanlara gore travma oncesi psikiyatrik hastaliga bagli ilac kullanim oykusu (p= 0.019), travma sonrasi fotofobi (p= 0.037), kusma (p= 0.029), bas donmesi (p= 0.019), uyku bozuklugu (p=

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Serenat Çitilcioğlu

Papers

The relationship between inferior vena cava diameter measured by bedside ultrasonography and central venous pressure value.

Relationship between mortality and acute inflammatory markers, erythrocyte cholinesterase, serum cholinesterase levels in the acute organic phosphorus intoxication

Minör kafa travması ve posttravmatik baş ağrısı arasındaki ilişki