Is there a relationship between the diameter of the inferior vena cava and hemodynamic parameters in critically ill patients
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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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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TL;DR: In this study, IVC diameters were found to correlate with central venous pressure, extravascular lung water index, intrathoracic blood volume index, the intrath oracic thermal volume, and the PaO( 2)/FiO(2) oxygenation index.
Abstract: Early optimization of fluid status is of central importance in the treatment of critically ill patients. This study aims to investigate whether inferior vena cava (IVC) diameters correlate with invasively assessed hemodynamic parameters and whether this approach may thus contribute to an early, non-invasive evaluation of fluid status. Thirty mechanically ventilated patients with severe sepsis or septic shock (age 60 ± 15 years; APACHE-II score 31 ± 8; 18 male) were included. IVC diameters were measured throughout the respiratory cycle using transabdominal ultrasonography. Consecutively, volume-based hemodynamic parameters were determined using the single-pass thermal transpulmonary dilution technique. This was a prospective study in a tertiary care academic center with a 24-bed medical intensive care unit (ICU) and a 14-bed anesthesiological ICU. We found a statistically significant correlation of both inspiratory and expiratory IVC diameter with central venous pressure ( p = 0.004 and p = 0.001, respectively), extravascular lung water index ( p = 0.001, p p = 0.026, p = 0.05, respectively), the intrathoracic thermal volume (both p 2 /FiO 2 oxygenation index ( p = 0.007 and p = 0.008, respectively). In this study, IVC diameters were found to correlate with central venous pressure, extravascular lung water index, intrathoracic blood volume index, the intrathoracic thermal volume, and the PaO 2 /FiO 2 oxygenation index. Therefore, sonographic determination of IVC diameter seems useful in the early assessment of fluid status in mechanically ventilated septic patients. At this point in time, however, IVC sonography should be used only in addition to other measures for the assessment of volume status in mechanically ventilated septic patients.
101 citations
TL;DR: Sonographic measurement of the inferior vena cava (IVC) caval index predicts central venous pressure in ED patients and is sought to determine if the caval index is an accurate measurement of FR inED patients.
Abstract: Objectives
Sonographic measurement of the inferior vena cava (IVC) caval index predicts central venous pressure in ED patients. Fluid responsiveness (FR) is a measure of preload dependence defined as an increase in cardiac output secondary to volume expansion. We sought to determine if the caval index is an accurate measurement of FR in ED patients.
Methods
We conducted a prospective, observational trial at an urban, academic, adult ED with an annual census >105 000. Included patients were clinically suspected of eu- and hypovolemia. Excluded patients were 10% by impedance cardiography (BioZ; Sonosite) following passive leg raise. The primary outcome was analysed using Spearman correlations for non-parametric data and the area under the receiver operating characteristics curve by Wilcoxon method.
Results
Thirty patients were enrolled; four were excluded because of incomplete data collection. Thirty-one per cent (95% CI 13–48) of the patients were FR. The mean initial caval and cardiac index were 15.8% (95% CI 9.5–22) and 2.9 L/min/m2 (95% CI 2.6–3.2), respectively. Caval index did not predict FR (receiver operating curve = 0.46, 95% CI 0.21–0.71, P = 0.63).
Conclusion
Bedside sonographic measurement of IVC caval index does not predict FR in a heterogeneous ED patient population. Further research using this technique in targeted patient subsets and a variety of shock etiologies is needed.
100 citations
"Is there a relationship between the..." refers background or result 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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...In recent years, the use of ultrasonographic measurement of the IVC diameter for evaluating volemic status and guide fluid resuscitation therapy in ED has gained popularity.[3,4,8,13] Many studies have focused on the relationship between the IVC diameter and fluid volume and contradictory results have been declared....
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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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TL;DR: Bedside ultrasound measurements of the IVC diameter and aortic measurements by BUS are not reliable indicators of intravascular volume (as determined by CVP) in acutely ill children.
Abstract: ObjectivesPrevious studies demonstrated that the collapsibility index (percent decrease in inferior vena cava [IVC] diameter with inspiration) of 50% or greater and an IVC/aorta ratio of 0.8 or less correlated with a low intravascular volume. Our study sought to determine if bedside ultrasound (BUS)
58 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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...The early detection of critically ill‐patients and a subsequent rapid initiation of effective treatment in emergency department (ED) increases the survival rates of these patients.[1,2] Of primary importance, respiratory or hemodynamic support should be used to stabilize their condition....
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TL;DR: The subxiphoid was the most reliably viewed of the three anatomic locations; however, the suprailiac view produced superior correlations to the CVP.
Abstract: Background Bedside ultrasound has been suggested as a non-invasive modality to estimate central venous pressure (CVP). Objective Evaluate a simple bedside ultrasound technique to measure the diameter of the inferior vena cava (IVC) and correlate to simultaneously measured CVP. Secondary comparisons include anatomic location, probe orientation, and phase of respiration. Methods An unblinded prospective observation study was performed in an emergency department and critical care unit. Subjects were a convenience sample of adult patients with a central line at the superior venocaval-atrial junction. Ultrasound measured transverse and longitudinal diameters of the IVC at the subxiphoid, suprailiac, and mid-abdomen, each measured at end-inspiration and end-expiration. Correlation and regression analysis were used to relate CVP and IVC diameters. Results There were 72 subjects with a mean age of 67 years (range 21–94 years), 37 (53%) male, enrolled over 9 months. Seven subjects were excluded for tricuspid valvulopathy. Primary diagnoses were: respiratory failure 12 (18%), sepsis 11 (17%), and pancreatitis 3 (5%). There were 28 (43%) patients mechanically ventilated. Adequate measurements were obtainable in 57 (89%) using the subxiphoid, in 44 (68%) using the mid-abdomen, and in 28 (43%) using the suprailiac views. The correlation coefficients were statistically significant at 0.49 (95% confidence interval [CI] 0.26–0.66), 0.51 (95% CI 0.23–0.71), and 0.50 (95% CI 0.14–0.74) for end-inspiratory longitudinal subxiphoid, midpoint, and suprailiac views, respectively. Transverse values were statistically significant at 0.42 (95% CI 0.18–0.61), 0.38 (95% CI 0.09–0.61), and 0.67 (95% CI 0.40–0.84), respectively. End-expiratory measurements gave similar or slightly less significant values. Conclusion The subxiphoid was the most reliably viewed of the three anatomic locations; however, the suprailiac view produced superior correlations to the CVP. Longitudinal views generally outperformed transverse views. A simple ultrasound measure of the IVC yields weak correlation to the CVP.
51 citations
TL;DR: IVC-CI and IVCe did not correlate with the magnitude of hemodynamic response to early hemorrhage.
Abstract: Background Ultrasonographic evaluation of the inferior vena cava (IVC) provides information on central hemodynamics and predicts fluid responsiveness during positive pressure ventilation. In spontaneously breathing patients, the correlations between IVC dynamics and the hemodynamic response to volume shifts remain to be described. Objectives We aimed to describe the correlation between IVC dynamics and the changes in cardiac output (CO) caused by controlled hemorrhage. Methods Healthy donors from the blood bank were eligible for inclusion. Measurements of the IVC and CO were performed before and immediately after blood donation using ultrasound methods. A control group served to evaluate the effect of resting. Results Thirty-seven participants completed the study. IVC collapsibility index (IVC-CI) and IVC end expiratory diameter (IVCe) both changed significantly after blood donation (p Conclusion IVC-CI and IVCe did not correlate with the magnitude of hemodynamic response to early hemorrhage. The sensitivity of serial IVC measurements was approximately 80% for detecting early blood loss.
48 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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