Original scientific article
Intensivist Use of Hand-Carried Ultrasonography to Measure IVC Collapsibility in Estimating Intravascular Volume Status: Correlations with CVP

https://doi.org/10.1016/j.jamcollsurg.2009.02.062Get rights and content

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 (<0.20, 0.20 to 0.60, and >0.60) demonstrated significant decrease in mean CVP as IVC-CI increased (p = 0.023). Although <5% of patients with IVC-CI <0.20 had CVP <7 mmHg, >40% of this group had a CVP >12 mmHg. Conversely, >60% of patients with IVC-CI >0.6 had CVP <7 mmHg.

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 (<0.20) and high (>0.60) collapsibility ranges. Additional studies are needed to confirm and expand on findings of this study.

Section snippets

Methods

A prospective evaluation of cardiac and hemodynamic status was conducted on 124 surgical intensive care unit (SICU) patients using a hand-carried ultrasonography unit (MicroMaxx with P17 1 to 5 MHz phased array probe; Sonosite). Evaluation included IVC assessment and evaluation of the heart for left ventricular ejection fraction, mitral valve inflow and tissue Doppler measurements, and cardiac filling.

Intensivist sonographers included emergency medicine faculty, emergency medicine

Results

The study was performed in a high-acuity combined trauma, general surgery, gynecology, otolaryngology, and thoracic SICU. A total of 124 patients were prospectively enrolled between October 2006 and April 2007. Of those patients, 101 had central venous catheters. This group consisted of 46 women and 55 men, with mean age of 58.3 ± 18.6 years (median age 60.5 years, range 21 to 85 years) and mean left ventricular ejection fraction of 61.5% by full-feature echocardiography. Among these patients,

Discussion

Assessment of intravascular volume status is an essential component of the care of critically ill patients. A variety of devices and parameters, including pulmonary artery catheter, CVP, esophageal Doppler, arterial waveform analysis, and mitral valve inflow and tissue Doppler have been advocated for this purpose.23 This range of options reflects the fact that that no single method is universally accepted. Likewise, each form of monitoring has its own spectrum of risks and benefits,1, 24, 25, 26

Author Contributions

Study conception and design: Stawicki, Kirkpatrick, Gracias, Dean

Acquisition of data: Panebianco, Hayden, Dean

Analysis and interpretation of data: Stawicki, Panebianco, Kirkpatrick, Hayden, Dean

Drafting of manuscript: Stawicki, Braslow, Panebianco, Gracias, Dean

Critical revision: Stawicki, Kirkpatrick, Gracias, Hayden, Dean

References (41)

  • Z. Reda et al.

    Effect of airway pressure on inferior vena cava pressure as a measure of central venous pressure in children

    J Pediatr

    (1995)
  • A.F. Connors et al.

    The effectiveness of right heart catheterization in the initial care of critically ill patientsSUPPORT Investigators

    JAMA

    (1996)
  • P.R. Eisenberg et al.

    Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients

    Crit Care Med

    (1984)
  • J.M. Brennan et al.

    Hand carried ultrasound measurement of the inferior vena cava for assessment of intravascular volume status in the outpatient hemodialysis clinic

    Clin J Am Soc Nephrol

    (2006)
  • E.C. Cheriex et al.

    Echography of the inferior vena cava is a simple and reliable tool for estimation of ‘dry weight’ in haemodialysis patients

    Nephrol Dials Transplant

    (1989)
  • I. Krause et al.

    Inferior vena cava diameter: a useful method for estimation of fluid status in children on haemodialysis

    Nephrol Dial Transplant

    (2001)
  • T. Kusaba et al.

    Echography of the inferior vena cava for estimating fluid removal from patients undergoing hemodialysis

    Nippon Jinzo Gakkai Shi

    (1996)
  • A. Toprak et al.

    Inferior vena cava diameter determines left ventricular geometry continuous ambulatory peritoneal dialysis patients: an echocardiographic study

    Nephrol Dial Transplant

    (2003)
  • S. Yanagiba et al.

    Utility of the inferior vena cava diameter as a marker of dry weight in nonoliguric hemodialyzed patients

    ASAIO J

    (2001)
  • B.G. Carr et al.

    Intensivist bedside ultrasound (INBU) for volume assessment in the intensive care unit: a pilot study

    J Trauma

    (2007)
  • Cited by (183)

    • Adult Cardiac Surgery-Associated Acute Kidney Injury: Joint Consensus Report

      2023, Journal of Cardiothoracic and Vascular Anesthesia
    View all citing articles on Scopus

    Disclosure Information: Nothing to disclose.

    View full text