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Journal Article•DOI•

Is there a relationship between the diameter of the inferior vena cava and hemodynamic parameters in critically ill patients

Şule Akköse Aydin1, Fatma Özdemir1, G Taskin1, G Ocakoglu1, H Yıldırım, Özlem Köksal1 •
Uludağ University1
01 Nov 2015-Nigerian Journal of Clinical Practice (Niger J Clin Pract)-Vol. 18, Iss: 6, pp 810-813
TL;DR: Measurement of IVC diameters, especially EAP may be useful at the monitoring of critically ill patients in ED, and significant correlation was found between the diameter of the IVC and CVP values as well as between the EAP diameter and Hmg, Hct, ScvO2 levels.
Abstract: Introduction: The early detection of critically ill patients together with the rapid initiation of effective treatment in emergency departments(ED) increase the survival rates. Aim: This study investigated whether a correlation exists between haemodynamic parameters of critically ill patients and the diameter of the inferior vena cava (IVC). Materials and Methods: A cross-sectional study was performed included patients aged ≥18 years with an unstable haemodynamic and/or respiratory status who were referred to the ED for non-traumatic issues. IVC diameters were measured by ultrasound (US) and then central venous pressures (CVP) were measured. Anteroposterior (AP) and mediolateral (ML) diameters of the IVC, both in the inspirium (IAP, IML) and expirium (EAP, EML), were measured by US. Results: 102 patients were evaluated with a median age of 59. The relationship between the diameters of IVC and CVP was evaluated and significant correlation was found in IAP, EAP according to CVP values (p' 0.001). ROC analyses were performed and significant relationship was found between the EAP diameter with haemoglobin (Hmg), haemotocrit (Hct), and central venous oxygen saturation (ScvO2) and also significant correlation was detected between the IAP diameter and white blood cell (WBC). Discussion: We detected significant correlation between the CVP and the IVC diameter in our study compatible with recent studies besides, significant correlation was found between the diameter of the IVC and CVP values as well as between the EAP diameter and Hmg, Hct, ScvO2 levels. Conclusion: Measurement of IVC diameters, especially EAP may be useful at the monitoring of critically ill patients in ED.

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Journal Article•DOI•
Influence of the Respiratory Cycle on Caudal Vena Cava Diameter Measured by Sonography in Healthy Foals: A Pilot Study.

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M.C. Tuplin1, A.E. Romero1, Søren R. Boysen1•
University of Calgary1
01 Aug 2017-Journal of Veterinary Internal Medicine
TL;DR: It is possible to reliably measure the caudal vena cava collapsibility index sonographically in healthy foals, and the CVC‐CI may prove useful in assessing the intravascular volume status in hypovolemic foals.
Abstract: Background Intravascular volume assessment in foals is challenging. In humans, intravascular volume status is estimated by the caudal vena cava (CVC) collapsibility index (CVC-CI) defined as (CVC diameter at maximum expiration [CVCmax] – CVC diameter at minimal inspiration [CVCmin])/CVCmax × 100%. Hypothesis/Objectives To determine whether the CVC could be sonographically measured in healthy foals, determine differences in CVCmax and CVCmin, and calculate inter- and intrarater variability between 2 examiners. We hypothesized that the CVC could be measured sonographically at the subxiphoid view and that there would be a difference between CVCmax and CVCmin values. Animals Sixty privately owned foals <1-month-old. Methods Prospective study. A longitudinal subxiphoid sonographic window in standing foals was used. The CVCmax and CVCmin were analyzed by a linear mixed effect model. Inter-rater agreement and intrarater variability were expressed by Bland-Altman and intraclass correlation coefficients, respectively. Results Measurements were attained from 58 of 60 foals with mean age of 15 ± 7.9 days and mean weight of 75.7 ± 17.7 kg. The CVCmax was significantly different from CVCmin (D = 0.515, SE = 0.031, P < 0.001). Inter-rater agreement of the CVC-CI differed by an average of −0.9% (95% limits of agreement, −12.5 to +10.7%). Intrarater variability of CVCmax was 0.540 and 0.545, of CVCmin was 0.550 and 0.594, and of CVC-CI was 0.894 and 0.853 for observers 1 and 2, respectively. Conclusions and Clinical Importance These results indicate it is possible to reliably measure the CVC sonographically in healthy foals, and the CVC-CI may prove useful in assessing the intravascular volume status in hypovolemic foals.

10 citations

Cites methods from "Is there a relationship between the..."

  • ...Recent studies have identified numerous deficiencies with the current methods used to estimate fluid status, including heart rate, blood pressure, physical examination findings, and laboratory findings.(4,12,14,15) A rapid and noninvasive method recently investigated to assess fluid status in humans involves the use of sonography to measure the change in diameter of the caudal vena cava (CVC) with inspiration and expiration....

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  • ...g, blood pressure, capillary refill time) used to indirectly assess volume status.(12) Experienced practitioners have identified the challenge of assessing intravascular volume status in foals....

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  • ...status to be better assessed with the changes in size of the CVC compared with larger arterial vessels such as the aorta.(12,14,21) Movement of the diaphragm also affects the collapsibility of the CVC,(19,28) although the importance of this finding is uncertain....

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Journal Article•DOI•
Ivc diameter and central venous pressure in shock patients

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Van Tuan Le, Anh Vu Nguyen
01 Apr 2018
References
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Journal Article•DOI•
Emergency Department Bedside Ultrasonographic Measurement of the Caval Index for Noninvasive Determination of Low Central Venous Pressure

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Arun Nagdev1, Roland C. Merchant1, Alfredo Tirado-Gonzalez1, Craig Sisson1, Michael Murphy1 •
Brown University1
01 Mar 2010-Annals of Emergency Medicine
TL;DR: Bedside ultrasonographic measurement of caval index greater than or equal to 50% is strongly associated with a low central venous pressure and could be a useful noninvasive tool to determine central venus pressure during the initial evaluation of the ED patient.
Abstract: Study objective Among adult emergency department (ED) patients undergoing central venous catheterization, we determine whether a greater than or equal to 50% decrease in inferior vena cava diameter is associated with a central venous pressure of less than 8 mm Hg. Methods Adult patients undergoing central venous catheterization were enrolled in a prospective, observational study. Inferior vena cava inspiratory and expiratory diameters were measured by 2-dimensional bedside ultrasonography. The caval index was calculated as the relative decrease in inferior vena cava diameter during 1 respiratory cycle. The correlation of central venous pressure and caval index was calculated. The sensitivity, specificity, and positive and negative predictive values of a caval index greater than or equal to 50% that was associated with a central venous pressure less than 8 mm Hg were estimated. Results Of 73 patients, the median age was 63 years and 60% were women. Mean time and fluid administered from ultrasonographic measurement to central venous pressure determination were 6.5 minutes and 45 mL, respectively. Of the 73 participants, 32% had a central venous pressure less than 8 mm Hg. The correlation between caval index and central venous pressure was –0.74 (95% confidence interval [CI] –0.82 to –0.63). The sensitivity of caval index greater than or equal to 50% to predict a central venous pressure less than 8 mm Hg was 91% (95% CI 71% to 99%), the specificity was 94% (95% CI 84% to 99%), the positive predictive value was 87% (95% CI 66% to 97%), and the negative predictive value was 96% (95% CI 86% to 99%). Conclusion Bedside ultrasonographic measurement of caval index greater than or equal to 50% is strongly associated with a low central venous pressure. Bedside measurements of caval index could be a useful noninvasive tool to determine central venous pressure during the initial evaluation of the ED patient.

255 citations

"Is there a relationship between the..." refers background in this paper

  • ...[2,5] Few studies have investigated the relationship between the diameter of the IVC and advanced hemodynamic and laboratory parameters.[9,12,13] In our study, no significant correlation was found between diameter of the IVC and advanced hemodynamic parameters....

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  • ...[5,8] Only a few studies have investigated correlations between the IVC diameter and hemodynamic parameters.[9,12,13] In one of these studies,[12] the IVC diameter was reported to be a better predictor than the pulse rate, and BP of acute blood loss....

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Journal Article•DOI•
Intensivist Use of Hand-Carried Ultrasonography to Measure IVC Collapsibility in Estimating Intravascular Volume Status: Correlations with CVP

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S. Peter Stawicki1, Benjamin M. Braslow1, Nova Panebianco1, James N. Kirkpatrick1, Vicente H. Gracias1, Geoffrey E. Hayden1, Anthony J. Dean1 •
University of Pennsylvania1
01 Jul 2009-Journal of The American College of Surgeons
TL;DR: Measurements of IVC-CI by INBU can provide a useful guide to noninvasive volume status assessment in SICU patients, and appears to correlate best with CVP in the setting of low (<0.20) and high (>0.60) collapsibility ranges.
Abstract: Background Volume status assessment is an important aspect of patient management in the surgical intensive care unit (SICU). Echocardiologist-performed measurement of IVC collapsibility index (IVC-CI) provides useful information about filling pressures, but is limited by its portability, cost, and availability. Intensivist-performed bedside ultrasonography (INBU) examinations have the potential to overcome these impediments. We used INBU to evaluate hemodynamic status of SICU patients, focusing on correlations between IVC-CI and CVP. Study Design Prospective evaluation of hemodynamic status was conducted on a convenience sample of SICU patients with a brief (3 to 10 minutes) INBU examination. INBU examinations were performed by noncardiologists after 3 hours of didactics in interpreting and acquiring two-dimensional and M-mode images, and ≥25 proctored examinations. IVC-CI measurements were compared with invasive CVP values. Results Of 124 enrolled patients, 101 had CVP catheters (55 men, mean age 58.3 years, 44.6% intubated). Of these, 18 patients had uninterpretable INBU examinations, leaving 83 patients with both CVP monitoring devices and INBU IVC evaluations. Patients in three IVC-CI ranges ( 0.60) demonstrated significant decrease in mean CVP as IVC-CI increased (p = 0.023). Although 40% of this group had a CVP >12 mmHg. Conversely, >60% of patients with IVC-CI >0.6 had CVP Conclusions Measurements of IVC-CI by INBU can provide a useful guide to noninvasive volume status assessment in SICU patients. IVC-CI appears to correlate best with CVP in the setting of low ( 0.60) collapsibility ranges. Additional studies are needed to confirm and expand on findings of this study.

227 citations

"Is there a relationship between the..." refers background in this paper

  • ...[3,4,8,13] Many studies have focused on the relationship between the IVC diameter and fluid volume and contradictory results have been declared.[1,4,8,11,14,15] Volemic status of patients has been estimated via pressures calculated by means of catheterizations of the pulmonary artery or the central vein....

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Journal Article•DOI•
Role of inferior vena cava diameter in assessment of volume status: a meta-analysis.

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Agarwal Dipti1, Zachary Soucy1, Alok Surana2, Subhash Chandra3•
Mayo Clinic1, Sarojini Naidu Medical College2, Greater Baltimore Medical Center3
01 Oct 2012-American Journal of Emergency Medicine
TL;DR: In this article, the authors conducted a meta-analysis to quantify existing evidence on sonographic measurement of inferior vena cava (IVC) diameter in assessing of volume status adult ED patients.
Abstract: Background and Objective Hypovolemic shock is an important cause of death in the emergency department (ED). We sought to conduct a meta-analysis to quantify existing evidence on sonographic measurement of inferior vena cava (IVC) diameter in assessing of volume status adult ED patients. Methods A search of 5 major databases of biomedical publication, EMBASE, Ovid Medline, evidence-based medicine (EBM) Reviews, Scopus, and Web of Knowledge, was performed in first week of March 2011. Studies meeting the following criteria were included: (1) prospectively conducted, (2) measured IVC diameter using ultrasonography, (3) inpatients under spontaneous ventilation, and (4) reported IVC diameter measurement with volume status or shock. Article search, study quality assessment, and data extraction were done independently and in duplicate. Mean difference in IVC diameter was calculated using RevMan version 5.5 (Cochrane collaboration). Results A total of 5 studies qualified for study eligibility from 4 different countries, 3 being case-control and 2 before-and-after design, studying 86 cases and 189 controls. Maximal IVC diameter was significantly lower in hypovolemic status compared with euvolemic status; mean difference (95% confidence interval) was 6.3 mm (6.0-6.5 mm). None of the studies blinded interpreters for volume status of participants. Conclusion Moderate level of evidence suggests that the IVC diameter is consistently low in hypovolemic status when compared with euvolemic. Further blinded studies are needed before it could be used in the ED with confidence.

200 citations

Journal Article•DOI•
Diagnosis and monitoring of hemorrhagic shock during the initial resuscitation of multiple trauma patients: a review

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Michael Wilson1, Daniel P. Davis2, Raul Coimbra2•
University of Arizona1, University of California, San Diego2
01 May 2003-Journal of Emergency Medicine
TL;DR: Available technologies used to assess fluid status and tissue perfusion in patients with blood loss or hemorrhagic shock are reviewed, and how these methods can be used effectively and efficiently during initial trauma resuscitation to guide therapy and disposition are discussed.
Abstract: The initial management of the multiple trauma victim requires evaluation for potential hemorrhage and ongoing monitoring to assess the efficacy of resuscitation and avoid complications related to hemorrhagic shock. A variety of strategies exist to assess circulatory status, including hemodynamic monitoring, tissue perfusion measurement, and use of serum markers of metabolism. We review available technologies used to assess fluid status and tissue perfusion in patients with blood loss or hemorrhagic shock, discuss how these methods can be used effectively and efficiently during initial trauma resuscitation to guide therapy and disposition, and suggest directions for future research to improve outcomes by providing more appropriate and timely care and avoiding unnecessary complications.

171 citations

"Is there a relationship between the..." refers background in this paper

  • ...[2,5] The CVP is a reliable parameter in the prediction of the volemic status of an organism in which there is normal myocardial function and an absence of any compression of the superior vena cava or occlusion of this vein.[5,8]...

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  • ...Because measurement of pulmonary artery pressure is a challenging procedure, it is rarely used in ED and CVP measurement is more frequently preferred.[2,5] The CVP is a reliable parameter in the prediction of the volemic status of an organism in which there is normal myocardial function and an absence of any compression of the superior vena cava or occlusion of this vein....

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  • ...These indicators are enable in the early detection of hypoperfusion developing at the tissue level when vital signs are within normal limits.[2,5] Few studies have investigated the relationship between the diameter of the IVC and advanced hemodynamic and laboratory parameters....

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  • ...Therefore, it reflects the volemic status of the body better than other arterial parameters, such as BP, pulse rate, and aortic diameter.[5,8] Only a few studies have investigated correlations between the IVC diameter and hemodynamic parameters....

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Journal Article•DOI•
Early diagnosis of hypovolemic shock by sonographic measurement of inferior vena cava in trauma patients.

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Youichi Yanagawa1, Kouichirou Nishi, Toshihisa Sakamoto, Yoshiaki Okada•
National Defense Medical College1
01 Apr 2005-Journal of Trauma-injury Infection and Critical Care
TL;DR: The diameter of the inferior vena cava was found to correlate with hypovolemia in trauma patients and was significantly smaller than in the control group.
Abstract: Background:The diameter of the inferior vena cava in trauma patients may be useful for evaluating hypovolemia.Methods:Between June 2003 and September 2003, 35 injured patients transferred to the authors’ hospital were prospectively investigated. They were divided into two groups: a shock group (n =

125 citations

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