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Prospective evaluation of intravascular volume status in critically ill patients: does inferior vena cava collapsibility correlate with central venous pressure?
J Trauma Acute Care Surg. 2014 Apr; 76(4):956-63; discussion 963-4.JT

Abstract

BACKGROUND

In search of a standardized noninvasive assessment of intravascular volume status, we prospectively compared the sonographic inferior vena cava collapsibility index (IVC-CI) and central venous pressures (CVPs). Our goals included the determination of CVP behavior across clinically relevant IVC-CI ranges, examination of unitary behavior of IVC-CI with changes in CVP, and estimation of the effect of positive end-expiratory pressure (PEEP) on the IVC-CI/CVP relationship.

METHODS

Prospective, observational study was performed in surgical/medical intensive care unit patients between October 2009 and July 2013. Patients underwent repeated sonographic evaluations of IVC-CI. Demographics, illness severity, ventilatory support, CVP, and patient positioning were recorded. Correlations were made between CVP groupings (<7, 7-12, 12-18, 19+) and IVC-CI ranges (<25, 25-49, 50-74, 75+). Comparison of CVP (2-unit quanta) and IVC-CI (5-unit quanta) was performed, followed by assessment of per-unit ΔIVC-CI/ΔCVP behavior as well as examination of the effect of PEEP on the IVC-CI/CVP relationship.

RESULTS

We analyzed 320 IVC-CI/CVP measurement pairs from 79 patients (mean [SD] age, 55.8 [16.8] years; 64.6% male; mean [SD] Acute Physiology and Chronic Health Evaluation II, 11.7 [6.21]). Continuous data for IVC-CI/CVP correlated poorly (R = 0.177, p < 0.01) and were inversely proportional, with CVP less than 7 noted in approximately 10% of the patients for IVC-CIs less than 25% and CVP less than 7 observed in approximately 85% of patients for IVC-CIs greater than or equal to 75%. Median ΔIVC-CI per unit CVP was 3.25%. Most measurements (361 of 320) were collected in mechanically ventilated patients (mean [SD] PEEP, 7.76 [4.11] cm H2O). PEEP-related CVP increase was approximately 2 mm Hg to 2.5 mm Hg for IVC-CIs greater than 60% and approximately 3 mm Hg to 3.5 mm Hg for IVC-CIs less than 30%. PEEP also resulted in lower IVC-CIs at low CVPs, which reversed with increasing CVPs. When IVC-CI was examined across increasing PEEP ranges, we noted an inverse relationship between the two variables, but this failed to reach statistical significance.

CONCLUSION

IVC-CI and CVP correlate inversely, with each 1 mm Hg of CVP corresponding to 3.3% median ΔIVC-CI. Low IVC-CI (<25%) is consistent with euvolemia/hypervolemia, while IVC-CI greater than 75% suggests intravascular volume depletion. The presence of PEEP results in 2 mm Hg to 3.5 mm Hg of CVP increase across the IVC-CI spectrum and lower collapsibility at low CVPs. Although IVC-CI decreased with increasing degrees of PEEP, this failed to reach statistical significance. While this study represents a step forward in the area of intravascular volume estimation using IVC-CI, our findings must be applied with caution owing to some methodologic limitations.

LEVEL OF EVIDENCE

Diagnostic study, level III. Prognostic study, level III.

Authors+Show Affiliations

From the Division of Trauma, Critical Care, and Burn (S.P.A.S., D.S.E., D.C.E., C.N., D.E.L., C.H.C.), Department of Surgery, Department of Emergency Medicine (E.J.A.,CTB., D.P.B.), and Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine (N.A.A.), Department of Internal Medicine, The Ohio State University College of Medicine; Department of Anesthesiology (A.N.S.), The Ohio State College of Medicine; and OPUS 12 Foundation Multi-Center Trials Group (S.P.A.S., D.C.E., D.E.L., C.H.C., S.C.G., D.P.B.), Columbus, Ohio; Department of Anaesthesiology and Critical Care (J.M.B., S.V.), Jubilee Mission Medical College and Research Institute, Thrissur, Kerala; and Department of Emergency Medicine (S.C.G.), Global Hospital Group, Mumbai, India.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 available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

24662857

Citation

Stawicki, Stanislaw P A., et al. "Prospective Evaluation of Intravascular Volume Status in Critically Ill Patients: Does Inferior Vena Cava Collapsibility Correlate With Central Venous Pressure?" The Journal of Trauma and Acute Care Surgery, vol. 76, no. 4, 2014, pp. 956-63; discussion 963-4.
Stawicki SP, Adkins EJ, Eiferman DS, et al. Prospective evaluation of intravascular volume status in critically ill patients: does inferior vena cava collapsibility correlate with central venous pressure? J Trauma Acute Care Surg. 2014;76(4):956-63; discussion 963-4.
Stawicki, S. P., Adkins, E. J., Eiferman, D. S., Evans, D. C., Ali, N. A., Njoku, C., Lindsey, D. E., Cook, C. H., Balakrishnan, J. M., Valiaveedan, S., Galwankar, S. C., Boulger, C. T., Springer, A. N., & Bahner, D. P. (2014). Prospective evaluation of intravascular volume status in critically ill patients: does inferior vena cava collapsibility correlate with central venous pressure? The Journal of Trauma and Acute Care Surgery, 76(4), 956-63; discussion 963-4. https://doi.org/10.1097/TA.0000000000000152
Stawicki SP, et al. Prospective Evaluation of Intravascular Volume Status in Critically Ill Patients: Does Inferior Vena Cava Collapsibility Correlate With Central Venous Pressure. J Trauma Acute Care Surg. 2014;76(4):956-63; discussion 963-4. PubMed PMID: 24662857.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective evaluation of intravascular volume status in critically ill patients: does inferior vena cava collapsibility correlate with central venous pressure? AU - Stawicki,Stanislaw P A, AU - Adkins,Eric J, AU - Eiferman,Daniel S, AU - Evans,David C, AU - Ali,Naeem A, AU - Njoku,Chinedu, AU - Lindsey,David E, AU - Cook,Charles H, AU - Balakrishnan,Jayaraj M, AU - Valiaveedan,Sebastian, AU - Galwankar,Sagar C, AU - Boulger,Creagh T, AU - Springer,Andrew N, AU - Bahner,David P, PY - 2014/3/26/entrez PY - 2014/3/26/pubmed PY - 2014/5/14/medline SP - 956-63; discussion 963-4 JF - The journal of trauma and acute care surgery JO - J Trauma Acute Care Surg VL - 76 IS - 4 N2 - BACKGROUND: In search of a standardized noninvasive assessment of intravascular volume status, we prospectively compared the sonographic inferior vena cava collapsibility index (IVC-CI) and central venous pressures (CVPs). Our goals included the determination of CVP behavior across clinically relevant IVC-CI ranges, examination of unitary behavior of IVC-CI with changes in CVP, and estimation of the effect of positive end-expiratory pressure (PEEP) on the IVC-CI/CVP relationship. METHODS: Prospective, observational study was performed in surgical/medical intensive care unit patients between October 2009 and July 2013. Patients underwent repeated sonographic evaluations of IVC-CI. Demographics, illness severity, ventilatory support, CVP, and patient positioning were recorded. Correlations were made between CVP groupings (<7, 7-12, 12-18, 19+) and IVC-CI ranges (<25, 25-49, 50-74, 75+). Comparison of CVP (2-unit quanta) and IVC-CI (5-unit quanta) was performed, followed by assessment of per-unit ΔIVC-CI/ΔCVP behavior as well as examination of the effect of PEEP on the IVC-CI/CVP relationship. RESULTS: We analyzed 320 IVC-CI/CVP measurement pairs from 79 patients (mean [SD] age, 55.8 [16.8] years; 64.6% male; mean [SD] Acute Physiology and Chronic Health Evaluation II, 11.7 [6.21]). Continuous data for IVC-CI/CVP correlated poorly (R = 0.177, p < 0.01) and were inversely proportional, with CVP less than 7 noted in approximately 10% of the patients for IVC-CIs less than 25% and CVP less than 7 observed in approximately 85% of patients for IVC-CIs greater than or equal to 75%. Median ΔIVC-CI per unit CVP was 3.25%. Most measurements (361 of 320) were collected in mechanically ventilated patients (mean [SD] PEEP, 7.76 [4.11] cm H2O). PEEP-related CVP increase was approximately 2 mm Hg to 2.5 mm Hg for IVC-CIs greater than 60% and approximately 3 mm Hg to 3.5 mm Hg for IVC-CIs less than 30%. PEEP also resulted in lower IVC-CIs at low CVPs, which reversed with increasing CVPs. When IVC-CI was examined across increasing PEEP ranges, we noted an inverse relationship between the two variables, but this failed to reach statistical significance. CONCLUSION: IVC-CI and CVP correlate inversely, with each 1 mm Hg of CVP corresponding to 3.3% median ΔIVC-CI. Low IVC-CI (<25%) is consistent with euvolemia/hypervolemia, while IVC-CI greater than 75% suggests intravascular volume depletion. The presence of PEEP results in 2 mm Hg to 3.5 mm Hg of CVP increase across the IVC-CI spectrum and lower collapsibility at low CVPs. Although IVC-CI decreased with increasing degrees of PEEP, this failed to reach statistical significance. While this study represents a step forward in the area of intravascular volume estimation using IVC-CI, our findings must be applied with caution owing to some methodologic limitations. LEVEL OF EVIDENCE: Diagnostic study, level III. Prognostic study, level III. SN - 2163-0763 UR - https://www.unboundmedicine.com/medline/citation/24662857/Prospective_evaluation_of_intravascular_volume_status_in_critically_ill_patients:_does_inferior_vena_cava_collapsibility_correlate_with_central_venous_pressure L2 - http://dx.doi.org/10.1097/TA.0000000000000152 DB - PRIME DP - Unbound Medicine ER -