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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•
Inferior vena cava diameter and collapsibility index: a practical non-invasive evaluation of intravascular fluid volume in critically-ill patients.

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Prasert Thanakitcharu1, Marisa Charoenwut, Napha Siriwiwatanakul•
Rangsit University1
01 Mar 2013-Journal of the Medical Association of Thailand Chotmaihet thangphaet
TL;DR: The authors conclude that the inferior vena cava diameter and collapsibility index (IVC-CI) can provide a useful guide for noninvasive intravascular volume status assessment of critically-ill patients.
Abstract: Background: Assessment of intravascular volume status is an essential parameter for the diagnosis and management of critically-ill patients. Generally, central venous pressure (CVP), which is an invasive measure, has been recommended for this purpose. Since CVP has been associated with many complications, inferior vena cava diameter and collapsibility index (IVC-CI) were used in the present study to evaluate the intravascular volume status of critically-ill patients at Rajavithi Hospital. Objective: To conduct a prospective, cross-sectional study to evaluate the IVC diameter as a guidance for estimating the volume status in critically-ill patients by bedside ultrasonography, focusing on correlations between CVP and IVC-CI and IVC diameter. Material and Method: Critically-ill patients who had been placed with a functioning central venous catheter were prospectively enrolled. Evaluation of intravascular volume status was performed by bedside ultrasonography to measure the IVC diameters (IVCD), both end-inspiratory (iIVCD) and end-expiratory (eIVCD). The IVC collapsibility indices (IVC-CI) were calculated by an equation and then were compared with the CVP values. Results: Of the 70 enrolled patients, with a mean age of 63.8 + 1.9 years, 64.3% were intubated. The most common indication of ICU admission was sepsis with hemodynamic instability (80.0%). The volume status of patients was stratified by their CVP levels as hypovolemic 15.7%, euvolemic 32.9% and hypervolemic 51.4% which correspond with the IVC-CI of 45.69 + 16.16%, 31.23 + 16.77%, and 17.82 + 12.36% respectively (p < 0.001). The highest significant correlation was found between the CVP and IVC-CI (r = -0.612, p < 0.001). In addition, there was a significant correlation between CVP and iIVCD (r = 0.535, p < 0.001); and between the CVP and mean IVCD (r = 0.397, p = 0.001). Conclusion: The present study supported the correlation between CVP and IVC-CI. The authors conclude that the IVC-CI can provide a useful guide for noninvasive intravascular volume status assessment of critically-ill patients. Keywords: Central venous pressure, Inferior vena cava diameter, Collapsibility index, Intravascular fluid volume, Ultrasonography

42 citations

"Is there a relationship between the..." refers methods or result in this paper

  • ...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....

    [...]

  • ...[1,2] Of primary importance, respiratory or hemodynamic support should be used to stabilize their condition.[3,4] Invasive and noninvasive parameters have been used for the diagnosis, management, and follow‐up of respiratory and hemodynamic stabilization....

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Journal Article•DOI•
Comparison of central venous and inferior vena caval pressures.

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John T. Walsh1, David J.R. Hildick-Smith1, Stuart A Newell, Martin Lowe1, Duwarakan K. Satchithananda1, Leonard M. Shapiro1 •
Papworth Hospital1
15 Feb 2000-American Journal of Cardiology
TL;DR: Inferior vena caval pressures were measured in 60 patients undergoing cardiac catheterization and compared with central venous pressure from within the right atrium, suggesting that the inferior vena cava provides a useful safe alternative for measuring central venus pressure.
Abstract: Inferior vena caval pressures were measured in 60 patients undergoing cardiac catheterization and compared with central venous pressure from within the right atrium. Mean pressures within the abdominal inferior vena cava were essentially the same as mean right atrial pressure, suggesting that the inferior vena cava provides a useful safe alternative for measuring central venous pressure.

31 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•
Microcirculatory responses to hypovolemic shock.

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Jacek Szopiński1, Krzysztof Kusza, Maria Semionow•
Cleveland Clinic1
01 Dec 2011-Journal of Trauma-injury Infection and Critical Care
TL;DR: Current insights into the changes in microcirculatory hemodynamics and their responses to hypovolemic conditions relevance to trauma patients are presented.
Abstract: The main role of the microcirculatory network is to allow the exchange of molecules between blood and tissue. Particularly, the exchange of oxygen, carbon dioxide, nutrients, hormones, cytokines, waste products, and heat takes place between circulating blood and parenchymal cells. Adequate blood flow within the microvascular network is an essential prerequisite for normal organ perfusion and function which determines normal hemodynamic conditions of the living organisms. Under shock conditions regardless of the resuscitation undertaken, microcirculatory abnormalities are known to persist long after successful patient resuscitation as assessed by central hemodynamic parameters. These abnormalities may be a major contributing factor to the development of postshock multiorgan dysfunction syndrome. Thus, microcirculatory network may be considered as special vital organ of cardiovascular system which functions to ensure adequate delivery of oxygen to various tissues1 and as a result, becomes a subject of interest to many investigators interested in improvement of hypovolemic shock treatment. The purpose of this review article is to present current insights into the changes in microcirculatory hemodynamics and their responses to hypovolemic conditions relevance to trauma patients. We have excluded discussion of septic shock classified as distributive hypovolemic shock because of its different and complicated pathophysiology described in other previously published articles.2–4

29 citations

Journal Article•
Correlation between inferior vena cava diameter and central venous pressure in critically ill patients.

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Weerapan Wiwatworapan, Nuchapa Ratanajaratroj, Buncha Sookananchai
01 Mar 2012-Journal of the Medical Association of Thailand Chotmaihet thangphaet
TL;DR: The measurement of the IVC diameter has a good correlation with CVP in Thai-population and useful for assessment of the volume status and may be an important additional evaluation of critically ill patients.
Abstract: Background The inferior vena cava (IVC) diameter is often used to estimate central venous pressure (CVP); however, the correlation and the cutoff of IVC compared with CVP have not yet been described in a Thai-population. Material and method A cross-sectional study evaluated the critically ill patients in the medical intensive care unit who had a central venous catheter inserted. The correlation between CVP and IVC diameter measured by a 2-dimensional, long-axis subxiphoid view at the end-expiratory phase with bedside ultrasonography were evaluated. Results Forty-seven patients with a mean age of 60 +/- 16 years (range, 18 to 91) were studied. Correlation (r) between end-expiration IVC diameter and CVP was 0.75 (95% CI 0.59-0.85; p or = 15 mm predicted CVP of 15 cmH2O (sensitivity 90% and specificity 89%). Conclusion The present study indicate that the measurement of the IVC diameter has a good correlation with CVP in Thai-population and useful for assessment of the volume status. The measurement of the IVC by ultrasonography may be an important additional evaluation of critically ill patients.

22 citations

"Is there a relationship between the..." refers background or methods or result 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....

    [...]

  • ...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....

    [...]

  • ...[1,2] Of primary importance, respiratory or hemodynamic support should be used to stabilize their condition.[3,4] Invasive and noninvasive parameters have been used for the diagnosis, management, and follow‐up of respiratory and hemodynamic stabilization....

    [...]

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Inferior vena cava diameter and collapsibility index: a practical non-invasive evaluation of intravascular fluid volume in critically-ill patients.

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