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Bedside sonographic measurement of the inferior vena cava caval index is a poor predictor of fluid responsiveness in emergency department patients.
Emerg Med Australas. 2012 Oct; 24(5):534-9.EM

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 <18 years old, pregnant, incarcerated, sustained significant trauma or unable to consent. Supine IVC diameter was measured by bedside ultrasonography (M-Turbo; Sonosite, Bothwell, WA, USA). Caval index = [(expiratory IVC diameter - inspiratory IVC diameter)/expiratory IVC diameter] × 100. FR was defined as an increase in the cardiac index by >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/m(2) (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.

Authors+Show Affiliations

Department of Emergency Medicine, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23039295

Citation

Corl, Keith, et al. "Bedside Sonographic Measurement of the Inferior Vena Cava Caval Index Is a Poor Predictor of Fluid Responsiveness in Emergency Department Patients." Emergency Medicine Australasia : EMA, vol. 24, no. 5, 2012, pp. 534-9.
Corl K, Napoli AM, Gardiner F. Bedside sonographic measurement of the inferior vena cava caval index is a poor predictor of fluid responsiveness in emergency department patients. Emerg Med Australas. 2012;24(5):534-9.
Corl, K., Napoli, A. M., & Gardiner, F. (2012). Bedside sonographic measurement of the inferior vena cava caval index is a poor predictor of fluid responsiveness in emergency department patients. Emergency Medicine Australasia : EMA, 24(5), 534-9. https://doi.org/10.1111/j.1742-6723.2012.01596.x
Corl K, Napoli AM, Gardiner F. Bedside Sonographic Measurement of the Inferior Vena Cava Caval Index Is a Poor Predictor of Fluid Responsiveness in Emergency Department Patients. Emerg Med Australas. 2012;24(5):534-9. PubMed PMID: 23039295.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bedside sonographic measurement of the inferior vena cava caval index is a poor predictor of fluid responsiveness in emergency department patients. AU - Corl,Keith, AU - Napoli,Anthony M, AU - Gardiner,Fenwick, Y1 - 2012/09/07/ PY - 2012/07/25/accepted PY - 2012/10/9/entrez PY - 2012/10/9/pubmed PY - 2013/3/5/medline SP - 534 EP - 9 JF - Emergency medicine Australasia : EMA JO - Emerg Med Australas VL - 24 IS - 5 N2 - 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 <18 years old, pregnant, incarcerated, sustained significant trauma or unable to consent. Supine IVC diameter was measured by bedside ultrasonography (M-Turbo; Sonosite, Bothwell, WA, USA). Caval index = [(expiratory IVC diameter - inspiratory IVC diameter)/expiratory IVC diameter] × 100. FR was defined as an increase in the cardiac index by >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/m(2) (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. SN - 1742-6723 UR - https://www.unboundmedicine.com/medline/citation/23039295/Bedside_sonographic_measurement_of_the_inferior_vena_cava_caval_index_is_a_poor_predictor_of_fluid_responsiveness_in_emergency_department_patients_ L2 - https://doi.org/10.1111/j.1742-6723.2012.01596.x DB - PRIME DP - Unbound Medicine ER -