ED Bedside Ultrasound guided volume assessment with IVC diameter
Date First Published:
February 7, 2002
Last Updated:
June 8, 2011
Report by:
M Azam Majeed, St6 (The Alexandra Hospital, Redditch)
Three-Part Question:
In [critically ill patients in ED] can [inferior vena cava (IVC) diameter] correlate with [fluid assesssment]?
Clinical Scenario:
A 65 yrs old gentleman presented to the ED with Acute SOB and high temperature with previous history of LVF. Will IVC diameter help decide whether we need to give or restrict fluids to treat him?
Search Strategy:
Medline
Embase 1980- may 2011
Amed 1985- May 2011
Cinhal 1981- May 2011
Cochrane
Google scholar
Embase 1980- may 2011
Amed 1985- May 2011
Cinhal 1981- May 2011
Cochrane
Google scholar
Search Details:
(inferior AND vena AND cava AND for AND fluid AND resuscitation).ti,ab
(inferior AND vena AND cava AND for AND fluid AND assessment).ti,ab
(inferior AND vena AND cava AND for AND fluid AND assessment).ti,ab
Outcome:
total 9 papers were retrieved and among them 3 were found relevant to 3 part question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Sonographic inferior vena cava/ aortic diameter index, a new approach to the body fluid status assessmentin children and young adults in emergency ultrasound. Kosiak W, Swieton D, Piskunowicz M. 2008, Poland | 52 healthy volunteers had IVC/Aortic index measured at fasting and 8hrs after 1500-2000ml of fluid. This IVC/Aortic index was compared with IVC/Aortic index of 7 pts with Hemolytic Uraemic Syndrome, Acute Renal Failure, Nephrotic syndrome and pericarditis to estimate the treatment response. | Diagnostic, comparative, prospective, single center study. | IVC/Aortaindex as a convenient way of evaluating body fluid status. | IVC/Ao index is very useful parameter in estimating body fluid status | Single center, selection bias, small number,training issues. |
| Intensivist bedside US for volume assessment in intensive care unit. Carr BG, Dean AJ, Everett WW et al. 2007, Pennsylvania | 70 patients from Surgical Intensive Care Unit had cardiac US and IVC diameter measured for volume assessment (Hypovolemic and Not hypovolemic). The reference standard was expert clinical judgment of pts volume status made by the Intensivists. | Prospective cross sectional, single blinded study of convenience sample. | The bedside US is a very feasible,potentially usefull and readily availabe modality. | The concordance rate between ECJ and cardiac US was 75% (p=0.11) | Small sample, convenience sample, selection bias, single center, no documentation of inter observer reliability(kappa score). No pt follow up documented. |
| The concordance rate between ECJ and IVC collapse index was 65%(p=0.72) | |||||
| The concordance rate between (ECJ)expert clinical judgment and IVC diameter was 67% (p= 0.56) | |||||
| The concordance rate between ECJ and CVP was 62% | |||||
| Intensivist Use of hand carried US to measure IVC collapsibility in estimating intravascular volume status: correlation with CVP. Stawicki SP, Braslow BM, Panebianco NL et al. 2009, Philadelphia | 124 surgical intensive care patients had IVC assessment and evaluation of left ventricular ejection fraction, mitral valve inflow, tissue doppler measurements and cardiac filling done. | Prospective, diagnostic, single center study. | To compare intensivist performed IVC evaluation (IVC-CI)with invasive CVP monitoring to determine how well they correlate. | The mean CVP values were inversely proportional to the IVC-CI (IVC collapsibility index). | Small number, single center, selection bias, no documentation of inter observer reliabilty score(kappa). |
| Pts with IVC-CI <0.20 the mean CVP was 12mm Hg | |||||
| In pts with IVC-CI >0.60 the mean CVP was 7.4mm Hg was | |||||
| In pts with IVC-CI 0.20-0.60 the mean CVP was 9 mm HG | |||||
| bedside IVC assessment(IVC-CI)can offer the treating clinician a rapid, easily repeated and non invasive adjunct in the assessment and management of critically ill patients. |
Author Commentary:
There isnt a great level of evidence available(level 3 and 4) in the literature but a large multicenter, double blinded study will be helpful to validate theses studies.
Bottom Line:
In view of available evidence ED ultrasound guided IVC diameter measurement is potentially a quick , easy and non invasive method for volume assessment in critically ill and trauma patients.
References:
- Kosiak W, Swieton D, Piskunowicz M.. Sonographic inferior vena cava/ aortic diameter index, a new approach to the body fluid status assessmentin children and young adults in emergency ultrasound.
- Carr BG, Dean AJ, Everett WW et al.. Intensivist bedside US for volume assessment in intensive care unit.
- Stawicki SP, Braslow BM, Panebianco NL et al.. Intensivist Use of hand carried US to measure IVC collapsibility in estimating intravascular volume status: correlation with CVP.