Abstract
Non-invasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava using ultrasound machines is nowadays promising with the increasing availability of these machines in emergency departments, critical care units and in operating theaters. The learning curve of these tools is steep and they are becoming less expensive and give quick, non-invasive, dynamic clue to the preload status. The aim of this study is to evaluate the transhepatic inferior vena cava (IVC) diameter by non-invasive sonographic imaging and compare it with that measured by subxiphoid approach to reveal the degree of agreement between them. This is a prospective study, done in a tertiary care referral hospital at intensive care unit in Al-Sadr Teaching Hospital over a period of four months from 1st February 2017 to 5th of June 2017. Eighty shocked patients were included for assessment of volume status. Bedside ultrasound images were obtained with the patient in supine position to determine the dimensions and collapsibility of IVC. Evaluation of each patient included the standard anterior subxiphoid IVC assessment and lateral transhepatic assessment of IVC by ultrasound using liver as an acoustic window in mid-axillary line. The IVC diameter was measured 2 cm caudal to the hepatic vein-IVC junction, or approximately 3-4 cm caudal to the junction of IVC and the right atrium. Then IVC maximal diameter, IVC minimal diameter and collapsibility index were calculated for both approaches. A comparison between these data was made. A total of eighty patients were included, 31 (37.5%) were females and 49 (62.5%) were males. Mean age was 45.81±14.89 years. The results showed that there is no statistically significant difference between transhepatic and subxiphoid approaches in regard to IVC diameter and its collapsibility. In conclusion, transhepatic lateral view of IVC provides a good alternative when subxiphoid anterior view cannot be obtained to guide fluid management in shocked patients.
Highlights
Sonography has traditionally been used to assess the anatomic abnormalities
Over the last decade, many clinical studies have led to the validation of sonography for evaluation of many critical cases as a first rapid assessment of pulmonary, cardiovascular and airway parameters in addition to being a bedside tool for focused assessment sonography of trauma (FAST) exam
Sonography provides dynamic interpretation of volumic status and fluid responsiveness by assessment of inferior vena cava (IVC) diameter change especially with spontaneous breathing based on heart-lung interactions[34,35]
Summary
Sonography has traditionally been used to assess the anatomic abnormalities. Its value in evaluating physiologic characteristics has recently been recognized in the care of patients with hypovolemia. As the use of point-of-care sonography grows in critical care and emergency medicine, noninvasive assessment of intravascular volume status is increasingly being used to guide therapy of the critically ill[1]. Severe hypotension due to hypovolemia or sepsis is continuously challenging the management of hospitalized patients by shock itself or by multi-organ failure that is caused by inadequate tissue perfusion. Fluid replacement without an accurate guide with a possibility of either underestimation or overestimation of fluid replacement gives a poor outcome in regard to morbidity and mortality in addition to the financial costs of prolonged hospital stay. Rapid and accurate assessment of volume status may
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