Abstract
ObjectivesTo determine the possibility of non-invasive estimation of central venous pressure (CVP) through inferior vena cava (IVC) analysis, using transthoracic echocardiography (TTE). DesignA prospective 3-year study. SettingA 16-bed medical/surgical Intensive Care Unit (ICU). MethodsPatients admitted to the ICU were enrolled. CVP measurement and TTE (determining cardiac chambers dimension and left ventricular shortening fraction) with IVC analysis (maximum dimension and IVC index) were performed simultaneously. Parametric and non-parametric statistical analysis was performed to establish correlations between variables. Results560 patients were admitted to the study, including 477 in whom IVC was analysed, aging 62.2±17.3 years, a mean ICU stay 11.9±18.7 days, a APACHE II score 23.9±8.9 and a SAPS II score 55.7±20.4. Through linear regression analysis CVP was influenced by IVC index (p=0.001), IVC maximum dimension (p=0.013) and presence of mechanical ventilation (p=0.002). A statistically significant correlation was found between the following parameters: an IVC index< 25% and a CVP >13mmHg; an IVC index and a CVP 26%-50%; an IVC index >51% and CVP< 7mmHg; an IVC maximum dimension > 20mm and a CVP >13mmHg; an IVC maximum dimension <10mmHg and CVP< 7mmHg. Patients with right ventricle enlargement presented a lack of agreement between IVC maximum dimension and CVP> 7mmHg was observed, and in patients with chronic respiratory failure (who presented a high prevalence of right ventricular enlargement) a lack of agreement between IVC index >50% and CVP< 7mmHg was also observed. ConclusionsIVC analysis is a possible way to noninvasively estimate CVP in a medical/surgical ICU. However, patients with right ventricular enlargement and admitted with chronic respiratory failure present a lack of agreement between IVC parameters and low values of CVP. IVC dimension is a marker of chronic disease and IVC index correlated better with CVP.
Highlights
Measuring volemia is a crucial step in assessing the state of health of a patient, a patient in an intensive care unit (ICU)
The patients had a median age of 62.2 years of age, had been admitted to hospital for an average of 11.9 days, had APACHE II indexes of 23.6, SAPS II indexes of 55.9 and a mortality rate of 30.1 %
Using transthoracic echocardiography (TTE) to analyse the inferior vena cava (IVC) (IVC index O parâmetro and maximum diameter) proves useful in the que melhor se non-invasive evaluation of Central venous pressure (CVP) in patients correlacionou admitted to a PICU
Summary
Measuring volemia is a crucial step in assessing the state of health of a patient, a patient in an intensive care unit (ICU). The relationship between the inferior vena cava (IVC) and the CVP was established over 20 years ago[7,8] These original studies show that diseases which affect the right heart can be identified by the repercussions in this vascular structure. Analysing the IVC’s respiratory kinetics allows a close analysis to be made of the venous return and the resistance met by the blood entering the right auricular. Some authors call this the “starling resistor”[13]. Jue et al 14 were unable to corre-
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