Inferior Vena Cava Collapsibility Research Articles

Inferior vena cava collapsibility index for predicting hypotension after spinal anesthesia in patients undergoing total knee arthroplasty.

This study aimed to identify risk factors associated with hypotension in patients undergoing total knee arthroplasty (TKA) under spinal anesthesia. Atotal of 200 patients (50-75years of age) who underwent elective TKA under spinal anesthesia between October 2023 and January 2024 were enrolled. Patients were divided into two groups (hypotensive and nonhypotensive) depending on the occurrence of postspinal anesthesia hypotension (PSAH). Patient characteristics (age, sex, body mass index, and medical history), blood pressure, heart rate, and ultrasound data before anesthesia were documented. Multivariate logistic regression models were used to determine risk factors for hypotension after spinal anesthesia. Furthermore, anomogram was constructed according to independent predictive factors. The area under the curve (AUC) and calibration curves were employed to assess the performance of the nomogram. In total, 175 patients were analyzed and 79(45.1%) developed PSAH. Logistic regression analysis revealed that variability of the inferior vena cava (odds ratio, OR, 1.147; 95% confidence interval, CI: 1.090-1.207; p < 0.001) and systolic arterial blood pressure (SABP, OR 1.078; 95% CI: 1.043-1.115; p < 0.001) were independent risk factors for PSAH. Receiver operating characteristic (ROC) curve analysis showed that the AUC of the inferior vena cava collapsibility index (IVCCI) and SABP alone were 0.806 and 0.701, respectively, while the AUC of both combined was 0.841. Specifically, an IVCCI of > 37.5% and systolic arterial blood pressure of > 157 mm Hg were considered threshold values. Furthermore, we found that the combination had abetter predictive value with higher AUC value, sensitivity, and specificity than the index alone. The nomogram model and calibration curves demonstrated the satisfactory predictive performance of the model. Elevated preoperative systolic arterial blood pressure and ahigher IVCCI were identified as independent risk factors for hypotension in patients receiving spinal anesthesia, which may help guide personalized treatment.

Inferior vena cava collapsibility index and trauma severity in elderly fall injuries.

Falls are a serious cause of morbidity and mortality among older people. One of the underlying causes of falls is dehydration. Therefore, ultrasonography has become an essential tool for evaluating volume status in the emergency department. However, the effect of volume status on falls in older people has not been evaluated before. The aim of this study was to determine the relationship between the inferior vena cava collapsibility index and the injury severity score in older patients who presented with fall-related injuries to the emergency department. A total of 66 patients were included in the study. The injury severity score was used as the trauma severity score, and the Edmonton Frail Scale was used as the frailty scale. Volume status was evaluated with inferior vena cava collapsibility index. The primary outcome measure was defined as the correlation between inferior vena cava collapsibility index and injury severity score. Secondary outcome measures were defined as the effect of inferior vena cava collapsibility index and injury severity score on hospitalization and mortality. There was no significant correlation between injury severity score and inferior vena cava collapsibility index (p=0.342). Neither inferior vena cava collapsibility index nor injury severity score was an indicator of the mortality of these patients. However, injury severity score was an indicator of hospitalization. The mean Edmonton Frail Scale score was an indicator of mortality among older people who experienced falls (p=0.002). Inferior vena cava collapsibility index cannot be used to predict trauma severity in older patients who have experienced falls admitted to the emergency department.

Diagnostic accuracy of subclavian vein versus inferior vena cava collapsibility index for predicting postinduction hypotension: An observational study

Background: Hypotension following induction of general anesthesia (GA) is commonly observed. Ultrasound (US) measurement of collapsibility index (CI) of the inferior vena cava (IVC) for predicting postinduction hypotension has been studied. As there is limited data available comparing the diagnostic accuracy of subclavian vein (SCV) versus IVC-CI, we performed this observational study. Methods: A total of 132 adult patients scheduled for elective surgery under GA were enrolled. US measurements of three readings of maximum and minimum diameters of SCV and IVC were recorded during both quiet and deep breathing, and the mean of three values was calculated. CI was derived using the formula: (dmax – dmin) × 100/dmax. Subsequently, GA was administered using standard technique, irrespective of the findings of SCV and IVC measurements. The administered drugs and dosage were recorded. Hemodynamic parameters were collected at baseline and then at every minute for the first 20 min. The primary objective was to compare the diagnostic accuracies of SCV-CI and IVC-CI for prediction of postinduction hypotension during quiet breathing. The secondary objectives were to compare the diagnostic accuracies during deep breathing and find the correlation between IVC-CI and SC-CI during quiet and deep breathing, incidence of hypotension, and time required to acquire US images. Results: Fifty-seven patients developed postinduction hypotension. During quiet breathing, SCV-CI ≥10% had a sensitivity of 68% and specificity of 56% (area under curve [AUC] [95% confidence interval {CI}] of 0.659 [0.56–0.75]; P = 0.002), while IVC-CI ≥34% had a sensitivity of 70% and specificity of 59% (AUC [95% CI] of 0.672 [0.58–0.76]; P = 0.001) for prediction of postinduction hypotension. During deep breathing, both SCV-CI and IVC-CI had moderate accuracy (P = 0.001 for both). Pearson’s correlation showed a significant positive correlation between SCV-CI and IVC-CI with a correlation coefficient (r) of 0.313 during quiet breathing and 0.379 during deep breathing (P &lt; 0.001). The time required for acquiring US images was significantly less for SCV compared to IVC during both quiet and deep breathing (P &lt; 0.001 for both). Conclusion: Both SCV-CI and IVC-CI were found to have good and comparable diagnostic accuracy for the prediction of postinduction hypotension. We also found a significant positive correlation between SCV-CI and IVC-CI. In comparison to IVC, US scanning of SCV took lesser time to acquire the images.

Inferior vena CAVA and lung ultraSound-guided therapy in acute heart failure: A randomized pilot study (CAVAL US-AHF study)

The optimal assessment of systemic and lung decongestion during acute heart failure is not clearly defined. We evaluated whether inferior vena cava (IVC) and pulmonary ultrasound (CAVAL US) guided therapy is superior to standard care in reducing subclinical congestion at discharge in patients with AHF. CAVAL US-AHF was an investigator-initiated, single-center, single-blind, randomized controlled trial. A daily quantitative ultrasound protocol using the 8-zone method was used and treatment was adjusted according to an algorithm. The primary endpoint was the presence of more than 5 B-lines and/or an increase in IVC diameter and collapsibility at discharge. And secondary endpoint exploratory outcome was the composite of readmission for HF, unplanned visit for worsening HF or death at 90 days RESULTS: Sixty patients were randomized to CAVAL US (n = 30) or control (n = 30). The primary endpoint was achieved in 4 patients (13.3%) in the CAVAL US group and 20 patients (66.6%) in the control group (P < .001). A significant reduction in HF readmission, unplanned visit for worsening HF or death at 90 days was seen in the CAVAL US group (13.3% vs 36.7%; log rank P = .038). Other endpoints such as NT-proBNP reduction at discharge showed a nonstatistically significant reduction in the CAVAL US group (48% IQR 27-67 vs 37% -3-59; P = .09). Safety outcomes were similar in both groups. IVC and lung ultrasound-guided therapy in AHF patients significantly reduced subclinical congestion at discharge. CAVAL US-AHF provides preliminary evidence for the potential use of a simple technique to guide decongestive therapy during hospitalization for AHF, which may reduce the composite outcome at 90 days.

IVC collapsibility indices in assessment of volume overload in neonatal cardiac patients

BackgroundFluid overload is associated with increased morbidity and mortality in critically ill patients. An accurate assessment of fluid status in neonatal cardiac pediatric patients is required for assessment of fluid overload. Estimation of fluid status using different Doppler parameters may be helpful in determination of fluid status.PurposeTo evaluate difference in fluid status in neonates with and without congenital heart diseases. To detect sensitivity of Doppler Ultrasound in early determination of fluid status. To compare between different parameters (IVC diameter, IVCCI, and IVC/AO ratio) between cardiac and healthy neonates.MethodsTransabdominal Doppler parameters of 25 full-term newborns with congenital heart diseases and congestive heart failure were compared to 25 post-natal age and sex-matched normal healthy neonates serving as controls. Aortic as well as inspiratory and expiratory inferior vena cava diameters were measured. Subsequently, inferior vena cava collapsibility index (IVCCI) and inferior vena cava-to-aortic ratio (IVC/AO) were calculated.ResultsFluid overload detected by increased IVC diameter (decreased IVCCI and increased IVC/AO ratio) was observed in the cardiac compared to the control group. There was positive correlation between the fluid volume and the IVC diameter and IVC/AO ratio and negative correlation with the IVC collapsibility indices.ConclusionsFluid overload with increased IVC diameter and lack of IVC collapsibility were observed in neonates with congenital heart diseases and congestive heart failure compared with those hemodynamically stable controls. We recommend the use of IVC diameter, IVCCI, and IVC/AO ratio as rapid, easy and sensitive parameters in assessing volume status.

A novel 4D volumetric M-mode ultrasound scanning technique for evaluation of intravascular volume and hemodynamic parameters

IntroductionWe use a novel 4-dimensional (4D) volumetric M-mode (VMM) ultrasound (US) technique to assess intravascular volume by monitoring the inferior vena cava (IVC). The VMM method expands the spatial coverage of standard M-mode scanning (depth vs time) by including lateral image direction and adds transducer tilt to cover the region surrounding the IVC. Current ultrasound methods for volume assessment suffer from intra- and inter-operator variability. The VMM technique aims to address these limitations, aiding in early detection of hypovolemia/hemorrhage and guiding resuscitation. Methods/technical approachThe 4D VMM technique was used on animals that underwent a swine hemorrhagic shock protocol with fluid resuscitation. 2D ultrasound images obtained were formatted in a 3D volume to capture changes over time in vessel size with respiration and volume status. Planes were then extracted from the 3D volume at multiple lateral locations to find and track the IVC. The vessel walls were manually traced on vertical planes (depth vs. time) to determine mean IVC diameter and IVC collapsibility at each measurement time point in the shock/resuscitation protocol. Planes at constant depth (lateral vs. time) were selected to extract respiratory and cardiac cycle data. ResultsMean IVC diameter in the baseline phase was significantly greater than in the hemorrhage phase (p = 0.020). There was no significant different in mean IVC diameter between baseline and resuscitation (p = 0.064) or hemorrhage and resuscitation phases (p = 0.531). There was no statistically significant difference in mean collapsibility or ΔIVC diameter between protocol phases. The 4D VMM technique effectively measured heart and respiratory rates, consistent with monitored vitals. Conclusion4D VMM identified IVC changes corresponding to blood loss and resuscitation during hemorrhagic shock as well as heart/respiratory rates. This innovative approach holds promise in reducing operator variability and providing actionable information during treatment of shock.

Prognostic association of circulating relaxin-2 in acute heart failure

BackgroundDespite the increasing interest in the study of the endogenous relaxin system in heart failure (HF), its role as a prognostic marker in acute HF remains unclear. We aimed to evaluate the association of relaxin-2 circulating levels with 6 months' mortality in acute HF. MethodsWe evaluated relaxin-2 serum levels at admission in a cohort of patients with acute HF (n = 202) using an enzyme immunoassay. The ability of relaxin-2 to predict all-cause death (primary outcome) and HF-specific death (secondary outcome) at 6 months was assessed using Cox-regression analysis. ResultsThe median age was 79 (70–85) years old, 44% of the patients were male, and 43% had preserved ejection fraction (≥50%). Median serum relaxin-2 level was 25 pg/mL. Patients with higher relaxin-2 levels had more peripheral oedemas, higher sodium retention score, higher pulmonary artery pressures, higher prevalence of right ventricle dysfunction and lower inferior vena cava collapse at inspiration. Conversely, there was no association with left chambers parameters or with B-type natriuretic peptide (BNP). Higher relaxin-2 concentrations were associated with a higher risk of all-cause death [HR 1.15; 95%CI 1.01,1.30; P = 0.030] and HF-specific death [HR 1.21; 95% CI 1.03–1.42; P = 0.018], after adjustment for classical prognostic factors such as age, sex and BNP. ConclusionsIn our acute HF population, relaxin-2 circulating levels were associated with clinical and echocardiographic markers of systemic congestion and with 6-months' mortality, independently of BNP. These results lay the groundwork for future investigations on the potential of relaxin-2 as an auxiliary biomarker in HF.

Inferior vena cava ultrasound to predict hypotension after general anesthesia induction: a systematic review and meta-analysis of observational studies.

Hypotension after induction of general anesthesia is common and is associated with significant adverse events. Identification of patients at high risk can inform the use of preoperative mitigation strategies. We conducted a systematic review and meta-analysis to assess the diagnostic accuracy of the inferior vena cava collapsibility index (IVC-CI) and maximal diameter (dIVCmax) in predicting postinduction hypotension and to identify their predictive performance across different threshold ranges. We searched MEDLINE, PubMed®, and Embase from inception to March 2023 for prospective observational studies exploring the performance of IVC-CI and dIVCmax in predicting postinduction hypotension in adults presenting for elective surgery under general anesthesia. We excluded studies reporting on IVC parameters predicting postinduction hypotension in the obstetric patient population or exclusively in patients with obesity. Trials screening and data extraction were conducted independently. We performed meta-analyses to identify the performance of IVC parameters in predicting postinduction hypotension, followed by subgroup analyses that sought the IVC-CI range with the highest hierarchical summary receiver-operating characteristic area under the curve (HSROC-AUC). We used a bivariate random effects model to calculate summary estimates. We evaluated study quality using Newcastle-Ottawa scores and certainty of evidence using the GRADE framework. We included 14 studies involving 1,166 patients. Pooled sensitivity and specificity of the IVC-CI to predict postinduction hypotension was 0.68 (95% confidence interval [CI], 0.55 to 0.79; coverage probability, 0.91) and 0.78 (95% CI, 0.69 to 0.85; coverage probability, 0.9), respectively, with an HSROC-AUC of 0.80 (95% CI, 0.68 to 0.85, high quality of evidence). An IVC-CI threshold range of 40-45% had an HSROC-AUC of 0.86 (95% CI, 0.69 to 0.93, high quality of evidence). Preoperative IVC-CI is a strong predictor of postinduction hypotension. We recommend that future studies use an IVC-CI threshold of 40-45% (low certainty of evidence). Future studies are needed to establish whether ultrasound-guided preoperative optimization improves outcomes in high-risk patients. PROSPERO ( CRD42022316140 ); first submitted 10 March 2022.

Correlation between Central Venous Pressure and Inferior Vena Cava Diameter for Fluid Assessment in Patients with Chronic Obstructive Pulmonary Disease

Abstract Background Chronic obstructive pulmonary disease (COPD) is now the third leading cause of death globally.3 Although COPD primarily affects the lungs, it is now also recognized as a complex multi-component disease characterized by chronic systemic inflammation that frequently coexists with other conditions known as co morbidities. Objective To determine the correlation between central venous pressure (CVP) and the IVC collapsibility index for estimating the fluid status in COPD patients. Patients and Methods After obtaining the approval of the Ain Shams University Ethical Committee and written informed consent, 20 patients aged 21 - 60 years of either sex, admitted in the ICU of Ain Shams teaching hospitals who have a functioning central venous catheter inserted for any clinical indication, were involved in this correlational study. CVP measurements were taken with the patient in the supine position from the zero point and the middle line. Results The current study showed that there was no statically significant correlation Between CVP (cmH2O) and Heart Rate (beat /min), MABP (mmHg), IVCd max (cm) and IVC CI % at Baseline, After PLR test, After Bolus fluid administration, After 3 hours and After 6 hours. Conclusion The measurement of the IVC diameter has a good correlation with CVP and useful for assessment of the volume status. The measurement of the IVC by ultrasonography may be an important additional evaluation of critically ill patients.

Assessment of Ultrasonographic Measurement of Inferior Vena Cava Collapsibility Index in the Prediction of Hypotension Associated with Tourniquet Release in Total Knee Replacement Surgeries under Spinal Anesthesia

Abstract This was a Prospective, observational study conducted on 60 patients with Total Knee Replacement (TKR); to characterize the collapsibility index of the IVC as a potential screening tool to identify patients who are candidate for hypotensive events after tourniquet release in TKR in an otherwise hemodynamically stable population. We found that; the mean age of all patients was (57 ± 5.6) years. Regarding gender of the patients, (58.3%) of patients were females; while (41.7%) were males. Regarding basic clinical data; the mean BMI of all patients was (25.7 ± 2.5); with (60%) of patients had DM, and (56.7%) had HTN. Regarding ASA class, (3.3%) had class I, (73.3%) had class II, and (23.3%) had class III. Regarding Baseline hemodynamic data; the average MAP was (104.6 ± 6) mmHg, the average RR was (10.5 ± 1.3) breath/min, and the average HR was (74.75 ± 7) beat/min. Regarding Data before tourniquet release; the average MAP was (102.3 ± 7.5) mmHg, the average RR was (10.7 ± 1.2) breath/min, and the average HR was (75.3 ± 6.5) beat/min, with average IVC-CI of (48.4 ± 7.7). Regarding Data 15-m after tourniquet release; the average MAP was (93.1 ± 9.3) mmHg, the average RR was (10.7 ± 1.4) breath/min, and the average HR was (76.45 ± 6.6) beat/min, with average IVC-CI of (51 ± 8.4). Regarding final outcome, (11.7%) of patients suffered Hypotension (PTRH). The 60 TKR patients were classified according to outcomes into 2 independent groups: group A IVCCI &amp;gt;55,5% (12 patients) and group B IVCCI &amp;lt;55,5% (48 patients). Regarding comparative study between the 2 groups as regards demographic data; no statistically significant differences were found except for ASA physical status of patients where group A had patients in ASA I class and most of its patients are ASA II while group B had no patients in ASA I class and a quarter of its patients were ASA III. Regarding comparative study between the 2 groups as regards hemodynamic and ultrasonographic data; no statistically different results were noted between groups in baseline readings. Results recorded before tourniquet release showed that IVC during inspiration reading was statistically lower while IVC collapsibility index was statistically higher in Group A when compared with group B . Results recorded 15 min after tourniquet release showed that IVC during inspiration reading was statistically lower while IVC collapsibility index was statistically higher in Group A when compared with group B, the IVC-CI before tourniquet release was not correlated with percent reduction in systolic blood pressure after tourniquet release in both groups with high (Group A) or low IVC-CI (Group B). Comparing patients who developed hypotension versus patients who did not, the 60 TKR patients were classified into hypotensive (7 patients) and normotensive (53 patients) groups. No statistically significant differences were found between hypotensive versus normotensive patients concerning demographic data and data recorded before tourniquet release. Baseline data showed significantly higher respiratory rate in hypotensive patients. Data recorded 15 min after tourniquet release showed statistically lower SBP, DBP and MAP, significantly higher HR and significantly lower IVC during inspiration and expiration in patients who developed hypotension. We studied different factors that may be included before tourniquet release that may predict the degree of PTRH by using ROC-curve analysis. IVC-CI before tourniquet release and BMI failed to be predictive factors for the occurrence of PTRH, while respiratory and heart rates before tourniquet release significantly predict the occurrence of PTRH. Performing multiple regression analysis using forward method showed that the increase in RR had an independent effect on increasing the probability of PTRH occurrence; with significant statistical difference (p &amp;lt; 0.039). Conclusion IVC-CI before tourniquet release is not a predictor for PTRH in patients undergoing TKR under spinal anesthesia.

Ongoing assertion of two-dimensional measurements on differentiation type of left ventricular hypertrophy: Focus on inferior vena cava.

Left ventricular hypertrophy (LVH), including hypertensive LVH, hypertrophic cardiomyopathy (HCM) and cardiac amyloidosis (CA), is a commonly encountered condition in cardiology practice, presenting challenges in differential diagnosis. In this study, we aimed to investigate the importance of echocardiographic evaluation of the inferior vena cava (IVC) in distinguishing LVH subtypes including hypertensive LVH, HCM, and CA. In this retrospective study, patients with common causes of LVH including hypertensive LVH, HCM, and CA were included. The role of echocardiographic evaluation of IVC diameter and collapsibility in distinguishing these causes of LVH was assessed in conjunction with other echocardiographic, clinical, and imaging methods. A total of 211 patients (45% HCM, 43% hypertensive heart disease, and 12% CA) were included in our study. Their mean age was 56.6 years and 62% of them were male. While mean IVC diameter was significantly dilated in CA patients (13.4mm in hypertensive LVH, 16.0mm in HCM, and 21.1mm in CA, p<.001), its collapsibility was reduced (IVC collapsible in 95% of hypertensive patients, 72% of HCM patients, and 12% of CA patients, p<.001). In the analysis of diagnostic probabilities, the presence of both hypovoltage and IVC dilation is significant for CA patients. Although it is not statistically significant, the presence of IVC dilation along with atrial fibrillation supports the diagnosis of HCM. In conclusion, although advances in imaging techniques facilitate the diagnosis of LVH, simple echocardiographic methods should never be overlooked. Our study supports the notion that IVC assessment could play an important role in the differential diagnosis of LVH.

Internal Jugular Vein Collapsibility Index versus Inferior Vena Cava Collapsibility Index Guided Preloading for Prevention of Spinal Anesthesia Induced Hypotension During LSCS: An Interventional Study

Background and Aims: Goal directed fluid therapy (GDFT) in parturients helps to prevent spinal anesthesia induced hypotension (SAIH) and volume overload. This interventional study compared the inferior vena cava collapsibility index (IVCCI) and the internal jugular vein collapsibility index (IJVCI) guided preloading for prevention of SAIH during lower segment ceserean section (LSCS) in terms of the incidence of SAIH as the primary outcome and the total amount of fluid, mean dose of the vasopressor, the number of boluses of vasopressor required, and the incidence of intra-operative complications as secondary outcomes. Methodology: A total of 144 full-term parturients aged 20–40 years with American society of anaesthesiologists (ASA) grade II, height (140–165 cms), weight (40–70 kgs), those who were fluid responders, and those who had a window period of 1 hour before surgery under spinal anesthesia (SA) undergoing LSCS were allocated into two groups (n = 72): group IJV and group IVC. Ultrasonography (USG) guided Internal jugular vein (IJV) and Inferior vena cava (IVC) collapsibility index (CI) was recorded an hour before spinal anesthesia (SA) as per the groups assigned and preloaded accordingly. After SA, the incidence of SAIH, the requirement of vasopressor, and fluid were recorded, and side effects were managed. Results: In group IVC, the incidence of SAIH (36.84%), mean dose (3.51 ± 5.02 µg), and mean boluses (0.44 ± 0.63) of norepinephrine required to manage hypotension were significantly lower than in group IJV, and the mean goal directed fluid administered before LSCS (504.46 ± 181.48 ml) and overall mean total fluid (1104.39 ± 160.99 ml) administered were significantly higher than in group IJV. Except for shivering, the incidence of all other complications was significantly lower in group IVC (p &lt; 0.05). Conclusion: Both IVCCI and IJVCI guided preloading are effective in combating SAIH during LSCS, but IVCCI is comparatively better than IJVCI for CI guided preloading.

Assessment of volume status of pediatric hemodialysis patients.

Accurate volume status assessment and dry weight achievement are the most challenging goals for a nephrologist. We aimed to evaluate the role of ultrasonographic parameters including lung ultrasound and inferior vena cava (IVC) measurements as practical methods of volume status assessment in children on hemodialysis by comparing them with established techniques, such as clinical evaluation and bioimpedance spectroscopy. A prospective cross-sectional study compared pre- and post-dialysis volume status using bioimpedance spectroscopy (BIS) parameters and clinical data with ultrasonographic lung B-lines and IVC parameters in children on regular hemodialysis. A total 60 children (mean age 9.4 ± 2.8years) were enrolled. Twenty patients (33.3%) were clinically overloaded to varying degrees (17 patients had mild to moderate signs of fluid overload and 3 patients had moderate to severe signs of fluid overload). All other patients (66.7%) were clinically euvolemic. Sonographic parameters were significantly lower post-dialysis than pre-dialysis, including lung B-line count and IVC diameter. IVC collapsibility index mean was significantly higher post-dialysis than pre-dialysis. There was a significant correlation between the lung B-line count, IVC parameters, and BIS-measured overhydration both before and after hemodialysis. Nine patients had ≥ 8 B-lines post-dialysis, only three of them were hypertensive. Clinical criteria alone are not specific for determining accurate fluid status in pediatric hemodialysis patients. Lung B-line score, IVC parameters, and BIS may be complementary to each other and to clinical data. Lung B-lines outperform IVC measurements and BIS in subclinical volume overload detection in pediatric hemodialysis patients.

Correlation of Internal Jugular Vein and Inferior Vena Cava Collapsibility Index with Direct Central Venous Pressure Measurement in Critically-ill Patients: An Observational Study.

Prompt assessments and quick replacement of intravascular fluid are critical steps to resuscitate hypovolemic patients. Intravascular volume assessment by direct central venous pressure (CVP) measurement is an invasive, time-consuming, and labor-intensive procedure. Nowadays, bedside ultrasound-guided volume assessment of the internal jugular vein (IJV) or inferior vena cava (IVC) is commonly employed as a proxy for direct CVP.Therefore, we examined the strength of association between CVP and collapsibility index (CI) of the IJV and IVC for evaluating the volume status of critically ill patients. Bedside USG-guided A-P diameter and cross-sectional area of the right IJV and IVC were measured, and their corresponding collapsibility indices were deduced. The results of the IJV and IVC indices were correlated with CVP. About 60 out of 70 enrolled patients were analyzed. The baseline clinical parameters of patients are shown in Table 1. For CSA and AP diameter, the correlations between CVP and IJV-CI at 0° were r = -0.107 (p = 0.001) and r = -0.092 (p = 0.001). Correlations between CVP and IJV-CI at 30° for CSA and diameter, however, were (r = -0.109, p = 0.001) and (r = -0.117, p = 0.001), respectively. Table 2 depicts the correlation between CVP and IVC-CI r = -0.503, p = 0.001 for CSA and r = -0.452, p = 0.001 for diameter. The IVC and IJV collapsibility indices can be used in place of invasive CVP monitoring to assess fluid status in critically ill patients. Kumar A, Bharti AK, Hussain M, Kumar S, Kumar A. Correlation of Internal Jugular Vein and Inferior Vena Cava Collapsibility Index with Direct Central Venous Pressure Measurement in Critically-ill Patients: An Observational Study. Indian J Crit Care Med 2024;28(6):595-600.

Ultrasound-guided inferior vena cava collapsibility index as a predictor of fluid responsiveness in septic cancer patients

Ultrasound-guided inferior vena cava collapsibility index as a predictor of fluid responsiveness in septic cancer patients

Contemporary echocardiographic assessment of pericardial effusion and cardiac tamponade

The aim: the aim of this review is to address the challenges in echocardiographic diagnosis of pericardial effusion, which can potentially lead to a lifethreatening condition called cardiac tamponade. This article discusses the possibilities and prognostic value of transthoracic echocardiography in the diagnosis of pericardial effusion and cardiac tamponade.Materials and Methods. An analysis of Russian and foreign literature was conducted using eLibrary and PubMed databases. The following keywords were used: «pericardial effusion», «cardiac tamponade», «constrictive pericarditis», «pericarditis», «pericarditis in echocardiography», «перикардиальный выпот», «перикардит», «тампонада сердца», «диагностика перикардита». The included scientific papers and articles were published from 2013 to 2023. The research method used in the analysis was descriptive-analytical.Results. Pericardial effusion is the accumulation of fluid in the pericardial cavity, which can lead to cardiac tamponade, disrupting normal hemodynamics and cardiac chamber filling, ultimately resulting in systemic hypotension and cardiac arrest. Therefore, it is a life-threatening condition that requires immediate verification, primarily through echocardiography, followed by the determination of treatment strategy. A structured approach, including 2D mode, M-mode, and Doppler echocardiographic assessment, evaluating the quantity and quality of pericardial fluid, cardiac chamber collapse, diastolic ventricular size variability with the respiratory cycle, paradoxical interventricular septum motion, inferior vena cava collapse, respiratory flow variation through valves, and blood flow in hepatic and pulmonary veins, should provide the treating physician with the necessary information for choosing the treatment method. This article discusses key echocardiographic features that will ensure the appropriate assessment of patients with pericardial effusion and/or cardiac tamponade. Among all the mentioned features, the absence of cardiac chamber collapse is likely to have the highest negative prognostic value for excluding cardiac tamponade.

#2058 IVC diameter and collapsibility via point-of-care ultrasound among clinically euvolemic Filipinos in Victoriano Luna Medical Center, Philippines

Abstract Background and Aims History, physical findings, and laboratory tests have limited sensitivity and specificity to assess relative intravascular volume or volume responsiveness. Inferior vena cava (IVC) ultrasound provides a direct assessment of relative intravascular volume status. The Journal of the American Society of Echocardiography (2010), recommended that an IVC diameter of &amp;lt;2.1 cm and collapsibility of &amp;gt;50% with a sniff indicates normal right atrial pressure of 3 mmHg (0-5 mmHg), while an IVC diameter of &amp;gt;2.1 cm with &amp;lt;50% inspiratory collapse indicates high right atrial pressure of 15 mmHg (10-20 mmHg). However, there have been occasions in the hospital setting wherein clinically hypervolemic Filipino patients were observed to have inferior vena cava diameters of less than 2.0 cm. This study aims to determine the average IVC diameter among clinically euvolemic Filipinos and to evaluate the applicability of standardized ultrasonographic IVC measurements in the Filipino population. Method This is a prospective observational study that included 45 clinically euvolemic patients and staff of Victoriano Luna Medical Center from 01 September 2023 to 01 November 2023. The demographic profile and anthropometric measurements of the volunteers were obtained. Ultrasound assessment was performed bedside and the IVC diameter was measured during passive respiration without sniff test 1 to 2 cm distal to the hepatic vein or 3 to 4 cm distal to the junction of the right atrium and inferior vena cava. The maximum and minimum diameters of the inferior vena cava was also measured using M-mode, and its collapsibility index was computed using the following formula: collapsibility index (CI) = (IVC max – IVC min) / IVC max. Categorical variables such as sex and comorbidities will be presented as frequencies and percentages while continuous variables such as age, body mass index, and inferior vena cava diameter and collapsibility will be presented as mean and standard deviation or median and interquartile range. Results The study group mainly consisted of males aged 65 years and below with normal body mass index for Asians. Cut-off values for the maximum inferior vena cava diameter were based on the venous excess ultrasound grading system, or VEXUS score, by Beaubien-Souligny et al. (2020) wherein congestion was considered at IVC diameters more than or equal to 2.0 cm. Of the 45 participants, 33 had maximum inferior vena cava diameter of less than 2.0 cm. Twenty-eight (28) out of 45 participants had a collapsibility index of more than 50%, which is indicative of normal right atrial pressure. Of the 33 with a maximum inferior vena cava diameter of less than 2.0 cm, 11 of which had a collapsibility index between 20 and 50%, and 22 with more than 50%. The remaining 12 participants had a maximum IVC diameter of more than or equal to 2.0 cm, with five having a collapsibility index between 20 and 50% and six with more than 50%. The mean maximum IVC diameter in the 45 volunteers on quiet respiration was 1.79 cm (+0.47), with an average computed collapsibility index of 54.43% (+19.78). Conclusion Thirty-three participants (73.33%) had a maximum inferior vena cava diameter of less than 2.0 cm, 22 of which have a collapsibility index of more than 50%. Among the 45 volunteers, the mean IVC maximum diameter on quiet respiration was 1.79 cm (+0.47), with an average computed collapsibility index of 54.43% (+19.78). Based on the results, standardized ultrasonographic IVC measurements can be applied on the Filipino population. Considering the Filipinos’ petite stature, the average IVC diameter among Filipinos is smaller and further investigation is warranted to establish clear cut-off values to identify plethoric IVCs in the Filipino setting.

Estimating the usefulness of inferior vena cava collapsibility index and caval aorta index to predict hypotension after spinal anaesthesia in adult patients undergoing elective surgery in a tertiary care hospital

Abstract Background and Aims: Post-spinal anaesthesia hypotension (PSAH) can occur in 25–75% of patients. The preload or volume status of a patient is an important contributor to PSAH, and coloading with fluids is advocated to prevent PSAH. Instead of blind volume loading, prediction of volume status using inferior vena cava (IVC) collapsibility index (IVCCI) and caval aorta index (IVC:Ao index) may be used to guide fluid administration. Material and Methods: In our study, we used ultrasound in the immediate pre-operative period to calculate IVCCI and IVC:Ao index in patients scheduled for elective surgery in the supine position, under spinal anaesthesia. Spinal anaesthesia was given in the lateral position with 0.5% hyperbaric bupivacaine. Patients were placed supine thereafter, sensory blockade level was ascertained, and blood pressure (BP) was measured every 2 min for 30 min. Episodes of hypotension were treated with fluids or vasopressors as per the discretion of the treating anaesthesiologist. In the study, 73 patients were screened, out of which 69 were included. Results: Totally, 23 participants out of 69 developed PSAH. The receiver operating characteristic (ROC) curve was made and the area under the curve analysis was done on our collected data. We found that IVC:Ao index has better sensitivity (0.696 for IVC:Ao index ≤0.810) and specificity (0.717 for IVC:Ao index ≤0.810) than IVCCI (sensitivity 0.522 and specificity 0.630 for IVCCI ≥33.32%) to predict PSAH. Conclusion: IVC:Ao index is a better predictor of PSAH than IVCCI. Thus, it may be used to predict volume status and guide in coloading with fluids during spinal anaesthesia.

#1319 “Peritoneal volume influence on bedside ultrasound or point-of-care ultrasonography (POCUS) volume assessment in peritoneal dialysis patients”

Abstract Background and Aims To study the variations in hydrosaline overload ultrasound parameters using PoCUS in PD patients with full and drained peritoneum and their correlation with clinical parameters. Method PoCUS and intra-abdominal pressure (IAP) measurements were performed on included patients with a full peritoneum. After drainage, a new PoCUS and a bioimpedance analysis (BIA) were conducted. Results Seventeen patients were included: 70.6% male, mean age 66 ± 9.5 years. 65% had hydrosaline overload &amp;gt;1L as assessed by BIA. The mean IAP was 15 ± 3.9 mmHg. The maximum diameter of the IVC with full and drained peritoneum was 1.44 ± 0.35 cm and 1.53 ± 0.4 cm, respectively, with no significant difference (p = 0.179). The % collapsibility of IVC with full and drained peritoneum was 49 ± 23% and 47 ± 13%, respectively, with no significant difference (p = 0.58). Kerley B-lines with full peritoneum were 1.3 ± 1.5, and with drained peritoneum were 0.71 ± 1.16, with this difference approaching statistical significance (p = 0.063). The same analyses in subgroups of patients with volume overload by BIA (OH&amp;gt;1 or OH/ECW&amp;gt;15%) did not show significant differences. In the correlation analysis of variables, IAP and peritoneal dialysis fluid volume per m2 of body surface did not correlate with the diameters or collapsibility of IVC with full or drained peritoneum. The degree of overhydration by OH (L) correlated with IVC collapsibility with drained peritoneum (Spearman ρ = −0.43; p = 0.08), as did the overhydration by OH/ECW (Spearman ρ = −0.61; p = 0.02). These correlations disappeared with full peritoneum (p &amp;gt; 0.05). The same correlation analyses were performed in subgroups of patients with volume overload by BIA (OH&amp;gt;1L or OH/ECW&amp;gt;15%) and were not significant with either full or drained peritoneum. Conclusion We did not find significant differences in the ultrasound volume overload parameters with full vs. drained peritoneum in PD patients. However, indirect data indicate a lower sensitivity of PoCUS to hydrosaline overload with a full peritoneum.

#201 Bedside lung ultrasound and bioimpedance spectroscopy for assessment of volume status in chronic kidney disease patients on hemodialysis

Abstract Background and Aims Fluid balance is important in patients with chronic kidney disease undergoing hemodialysis (HD). Majority of HD treatment incorporate a prescription for fluid removal targeted to patient's dry weight. Overestimation of dry weight causes hypertension, left ventricular hypertrophy and heart failure, while underestimation is responsible for chronic dehydration leading to the risk of hypotension. Both complications have a significant impact on the overall morbidity and mortality. Dry weight of the patient is usually assessed by using clinical parameters (edema, BP, JVP etc.), Biochemical parameters (BNP, ANP), Bioimpedance Spectroscopy (BIS) or IVC diameter and collapsibility on ultrasound (VCI index). The use of chest ultrasound to detect lung water has recently received growing attention in clinical research. Ultrasonographic lung comets (counting B-lines artifact) evaluate extravascular lung water and hence is considered as a useful tool to evaluate the hydration status of hemodialysis patients. This study aims to compare the efficacy of body fluid volume status and lung water assessment by clinical methods, Ultrasound chest and Bioimpedance Spectroscopy in chronic kidney disease patients on hemodialysis. Method A cross-sectional study was conducted over a period of 6 months. Dry weight of the patient was assessed by the attending nephrologist based on clinical criteria such as: weight, blood pressure, presence of edema or vascular congestion. A Longitudinal Ultrasound scan of the chest was performed using MicroMaxx Ultrasound System with patient in supine position from second to fourth intercostal space of left hemi-thorax and second to fifth intercostal space of right hemi-thorax along parasternal, midclavicular, anterior axillary and midaxillary lines of each side in a total of 28 sectors. B-lines were defined as hyperechogenic linear artifact emerging from the pleural line, up to the bottom of the screen. Pre and Post dialysis comet score was determined by calculating the total B-lines in each sector. Bioimpedance spectroscopy using Bodystat QuadScan 4000 was performed. Pre and post dialysis total body water (TBW), intracellular water (ICW), extracellular water (ECW) and residual fluid overload (ECW pre HD- ECW post HD) were recorded. Results We conducted 100 assessments on 34 patients presenting to the hospital for maintenance hemodialysis. The mean age of the study population was 54.3 + 11 years with a sex ratio (M/F) of 6:1. Mean systolic blood pressure was 141.1 + 19 mmHg and diastolic blood pressure was 83 + 9.3 mmHg with 3 episodes of intradialytic hypotension. The mean dry weight was 59.8 + 10 Kg and weight gain by clinical assessment was 2.1 + 1.5 Kg. Comet score assessed by ultrasound chest had a mean of 4.54 + 2.53 before dialysis and 1.73 ± 1.36 after dialysis. Residual fluid overload on Bio impedance spectroscopy was 1.11 ± 0.85 litre. The residual fluid overload on Bio impedance spectroscopy and lung ultrasound comet score after dialysis had a significant correlation (p value &amp;lt;0.0001). Of the 100 assessments, 40% had fluid overload after dialysis on Bio impedance and 35% had lung congestion on ultrasound chest even after achieving euvolemia according to the dry weight assessed clinically. Conclusion Lung comets on ultrasound chest and residual volume on bio impedance spectroscopy may precede the development of clinical sign and symptoms in a patient. Therefore, these methods are superior to clinical volume status assessment in chronic kidney disease patients on hemodialysis.