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Sonographic evaluation of intravascular volume status in the surgical intensive care unit: a prospective comparison of subclavian vein and inferior vena cava collapsibility index.
J Surg Res. 2013 Sep; 184(1):561-6.JS

Abstract

BACKGROUND

Traditional methods for intravascular volume status assessment are invasive and are associated significant complications. While focused bedside sonography of the inferior vena cava (IVC) has been shown to be useful in estimating intravascular volume status, it may be technically difficult and limited by patient factors such as obesity, bowel gas, or postoperative surgical dressings. The goal of this investigation is to determine the feasibility of subclavian vein (SCV) collapsibility as an adjunct to IVC collapsibility in intravascular volume status assessment.

METHODS

A prospective study was conducted on a convenience sample of surgical intensive care unit patients to evaluate interchangeability of IVC collapsibility index (IVC-CI) and SCV-CI. After demographic and acuity of illness information was collected, all patients underwent serial, paired assessments of IVC-CI and SCV-CI using portable ultrasound device (M-Turbo; Sonosite, Bothell, WA). Vein collapsibility was calculated using the formula [collapsibility (%) = (max diameter - min diameter)/max diameter × 100%]. Paired measurements from each method were compared using correlation coefficient and Bland-Altman measurement bias analysis.

RESULTS

Thirty-four patients (mean age 56 y, 38% female) underwent a total of 94 paired SCV-CI and IVC-CI sonographic measurements. Mean acute physiology and chronic health evaluation II score was 12. Paired SCV- and IVC-CI showed acceptable correlation (R(2) = 0.61, P < 0.01) with acceptable overall measurement bias [Bland-Altman mean collapsibility difference (IVC-CI minus SCV-CI) of -3.2%]. In addition, time needed to acquire and measure venous diameters was shorter for the SCV-CI (70 s) when compared to IVC-CI (99 s, P < 0.02).

CONCLUSIONS

SCV collapsibility assessment appears to be a reasonable adjunct to IVC-CI in the surgical intensive care unit patient population. The correlation between the two techniques is acceptable and the overall measurement bias is low. In addition, SCV-CI measurements took less time to acquire than IVC-CI measurements, although the clinical relevance of the measured time difference is unclear.

Authors+Show Affiliations

Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio 43210, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

23764308

Citation

Kent, Alistair, et al. "Sonographic Evaluation of Intravascular Volume Status in the Surgical Intensive Care Unit: a Prospective Comparison of Subclavian Vein and Inferior Vena Cava Collapsibility Index." The Journal of Surgical Research, vol. 184, no. 1, 2013, pp. 561-6.
Kent A, Bahner DP, Boulger CT, et al. Sonographic evaluation of intravascular volume status in the surgical intensive care unit: a prospective comparison of subclavian vein and inferior vena cava collapsibility index. J Surg Res. 2013;184(1):561-6.
Kent, A., Bahner, D. P., Boulger, C. T., Eiferman, D. S., Adkins, E. J., Evans, D. C., Springer, A. N., Balakrishnan, J. M., Valiyaveedan, S., Galwankar, S. C., Njoku, C., Lindsey, D. E., Yeager, S., Roelant, G. J., & Stawicki, S. P. (2013). Sonographic evaluation of intravascular volume status in the surgical intensive care unit: a prospective comparison of subclavian vein and inferior vena cava collapsibility index. The Journal of Surgical Research, 184(1), 561-6. https://doi.org/10.1016/j.jss.2013.05.040
Kent A, et al. Sonographic Evaluation of Intravascular Volume Status in the Surgical Intensive Care Unit: a Prospective Comparison of Subclavian Vein and Inferior Vena Cava Collapsibility Index. J Surg Res. 2013;184(1):561-6. PubMed PMID: 23764308.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sonographic evaluation of intravascular volume status in the surgical intensive care unit: a prospective comparison of subclavian vein and inferior vena cava collapsibility index. AU - Kent,Alistair, AU - Bahner,David P, AU - Boulger,Creagh T, AU - Eiferman,Daniel S, AU - Adkins,Eric J, AU - Evans,David C, AU - Springer,Andrew N, AU - Balakrishnan,Jayaraj M, AU - Valiyaveedan,Sebastian, AU - Galwankar,Sagar C, AU - Njoku,Chinedu, AU - Lindsey,David E, AU - Yeager,Susan, AU - Roelant,Geoffrey J, AU - Stawicki,Stanislaw P A, Y1 - 2013/06/03/ PY - 2013/01/04/received PY - 2013/04/03/revised PY - 2013/05/09/accepted PY - 2013/6/15/entrez PY - 2013/6/15/pubmed PY - 2013/11/8/medline KW - Hemodynamic resuscitation KW - Inferior vena cava KW - Intravascular volume status assessment KW - Point-of-care testing KW - Portable ultrasound KW - Subclavian vein KW - Surgical intensive care unit KW - Venous collapsibility index SP - 561 EP - 6 JF - The Journal of surgical research JO - J. Surg. Res. VL - 184 IS - 1 N2 - BACKGROUND: Traditional methods for intravascular volume status assessment are invasive and are associated significant complications. While focused bedside sonography of the inferior vena cava (IVC) has been shown to be useful in estimating intravascular volume status, it may be technically difficult and limited by patient factors such as obesity, bowel gas, or postoperative surgical dressings. The goal of this investigation is to determine the feasibility of subclavian vein (SCV) collapsibility as an adjunct to IVC collapsibility in intravascular volume status assessment. METHODS: A prospective study was conducted on a convenience sample of surgical intensive care unit patients to evaluate interchangeability of IVC collapsibility index (IVC-CI) and SCV-CI. After demographic and acuity of illness information was collected, all patients underwent serial, paired assessments of IVC-CI and SCV-CI using portable ultrasound device (M-Turbo; Sonosite, Bothell, WA). Vein collapsibility was calculated using the formula [collapsibility (%) = (max diameter - min diameter)/max diameter × 100%]. Paired measurements from each method were compared using correlation coefficient and Bland-Altman measurement bias analysis. RESULTS: Thirty-four patients (mean age 56 y, 38% female) underwent a total of 94 paired SCV-CI and IVC-CI sonographic measurements. Mean acute physiology and chronic health evaluation II score was 12. Paired SCV- and IVC-CI showed acceptable correlation (R(2) = 0.61, P < 0.01) with acceptable overall measurement bias [Bland-Altman mean collapsibility difference (IVC-CI minus SCV-CI) of -3.2%]. In addition, time needed to acquire and measure venous diameters was shorter for the SCV-CI (70 s) when compared to IVC-CI (99 s, P < 0.02). CONCLUSIONS: SCV collapsibility assessment appears to be a reasonable adjunct to IVC-CI in the surgical intensive care unit patient population. The correlation between the two techniques is acceptable and the overall measurement bias is low. In addition, SCV-CI measurements took less time to acquire than IVC-CI measurements, although the clinical relevance of the measured time difference is unclear. SN - 1095-8673 UR - https://www.unboundmedicine.com/medline/citation/23764308/Sonographic_evaluation_of_intravascular_volume_status_in_the_surgical_intensive_care_unit:_a_prospective_comparison_of_subclavian_vein_and_inferior_vena_cava_collapsibility_index_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-4804(13)00490-3 DB - PRIME DP - Unbound Medicine ER -