Initial inferior vena cava and aorta diameter parameters measured by ultrasonography or computed tomography does not correlate with vital signs, hemorrhage or shock markers in trauma patients

Çelik, Ömer; Akoğlu, Haldun; Çelik, Ali; Asadov, Ruslan; Onur, Özge; Denizbaşı, Arzu

doi:10.5505/tjtes.2017.72365

Cited by 4 publications

(6 citation statements)

References 20 publications

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“…The utility of a single, static ultrasound assessment of the IVC in acute trauma patients was not supported by a study of 140 acute trauma admissions found that a single ultrasonographic or computed tomographic measurement of IVC diameter did not correlate with vital signs, hemorrhage or shock markers. (33) In our study, we also did not see differences in vital signs or shock markers based on IVCMIN or IVCCI at admission. However, the use of repeated US examinations and provocative tests may increase the predictive ability of US assessment of IVCDMIN and IVCCI for FR.…”

Section: Discussioncontrasting

confidence: 41%

Ultrasonographic inferior vena cava diameter response to trauma resuscitation after 1 hour predicts 24-hour fluid requirement

Doucet

Ferrada

Murthi

et al. 2019

J Trauma Acute Care Surg

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Introduction: Identification of occult hypovolemia in trauma patients at admission can be difficult without additional laboratory evaluation or advanced imaging. We hypothesized that in acute trauma patients, the response of ultrasound-measured minimum inferior vena cava diameter (IVCD MIN ), IVC Collapsibility Index (IVCCI) or minimum internal jugular diameter (IJVD MIN ) or IJV Collapsibility Index (IJVCI) in repeated ultrasound examinations (USA-IVC) during up to 1 hour of standard-of-care intravenous fluid resuscitation would predict 24hour resuscitation intravenous fluid requirements (24FR). Methods: An NTI funded, AAST-MITC group prospective, multi-institutional cohort trial was conducted at 4 Level I Trauma Centers. Major trauma patients were screened in the supine position for an IVCD of 12 mm or IVCCI of 50% or less on the initial FAST examination for enrollment. A second IVCD was obtained 40-60 minutes later, after the patient received standard-of-care fluid resuscitation. Patients whose second measurement IVCD was less than 10mm were deemed Non-Responders (NON-RESP), those at or greater than 10mm were Responders (RESP). Prehospital fluid, initial resuscitation fluid and 24FR were recorded. Demographics, ISS, arterial blood gasses, ICU admission, length-of-stay, interventions and complications were recorded. Means were compared by ANOVA and categorical variables were compared via Chi-square. Receiver-operator characteristic (ROC) curves and gray area analysis were used to compare the IVC and IJV measures and to Base Excess (BE), ISS and other 24FR predictors.Results: There were 4798 patients screened by FAST-IVC, 196 were identified with admission IVCD of 12 mm or IVCCI of 50% or less, 144 were enrolled and had useable Abstract imagery. After 1 hour of standard of care resuscitation, there were 86 RESP and 58 NON-RESP. There were no significant differences between groups in demographics. initial hemodynamics or laboratory measures. NON-RESP had smaller IVCD (6.0mm ± 3.7 vs.14.2mm ± 4.3, p< 0.001) and higher IVCCI 41.7% ± 30.0 vs. 13.2% ± 12.7, p< 0.001) but no significant difference in IJVD or IJVCCI. RESP had significantly greater 24FR than NON-RESP (2503ml ± 1751 vs. 1243ml ± 1130 0.003). ROC analysis indicates IVCD MIN predicted 24FR (AUC= 0.74, C.I.: 0.64-0.84, p<0.001) as did IVCCI (AUC= 0.75, C.I.: 0.65-0.85, p<0.001) not IJVD (AUC= 0.48, C.I.: 0.24-0.60, p=N.S.) or IVCCI (AUC= 0.54, C.I.: 0.42-0.67, p=N.S.) and more predictive than ISS (AUC=0.65, C.I.:0.54-0.76, p=0.007) in predicting 24FR. Conclusion: Ultrasound assessed IVCD MIN and IVCCI but not IJ diameter response to initial major trauma patient resuscitation predicts 24-hour fluid resuscitation requirements.

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Section: Discussioncontrasting

confidence: 41%

Ultrasonographic inferior vena cava diameter response to trauma resuscitation after 1 hour predicts 24-hour fluid requirement

Doucet

Ferrada

Murthi

et al. 2019

J Trauma Acute Care Surg

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“…Also, there was a negative correlation between ICV with SBP. Our results are in line with Çelik et al [9] who revealed that there was a significant association between ICV distensibility index and SBP. However, Jassim et al [10] reported that there was no significant association was found between CVP and MAP or HR.…”

Section: Discussionsupporting

confidence: 93%

Inferior Vena Cava Dispensability Index versus Central Venous Pressure in Volume Status Assessment in Shocked Patients

Abd Alfatah,

Nour –Eldeen,

Diab

2023

International Journal of Medical Arts

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Article informationBackground: The central venous pressure [CVP] remains the most frequently used variable to guide fluid resuscitation in shocked patients and is considered a direct measurement of the blood pressure in the right atrium and vena cava. The ultrasound-guided measurement of the inferior vena cava [IVC] and its changes with respiration has recently been utilized to calculate a patient's fluid status.The Aim of the work: This work aimed to compare ultrasound guided inferior vena cava dispensability index to central venous pressure in shocked patients and to assess the volume status in shocked patients after measurement of CVP and IVC dispensability index [IVC DI]. Patients and Methods:The study was conducted on 60 shocked patients, who were selected from the ICU, Al-Azhar University Hospitals.Results: At cutoff point 7.5 cmH2O, CVP has a sensitivity of 97% and specificity of 96.3% for prediction of hypovolemia. Also, at cutoff point 15.5, IVC-DI has sensitivity of 93.9% and specificity of 100% to predict hypovolemia. In addition, CVP at cutoff point 8.5 cmH2O has sensitivity of 50% and specificity of 55% for predicting fluid responsiveness. Also, at cutoff point 14.5 IVC DI has sensitivity of 100% and specificity of 91.9% for predicting fluid responsiveness. Conclusion:Ultrasound guided CVP and IVC DI were reliable markers in predicting fluid responsiveness and hypovolemia among shocked patients. IVC DI was superior than central CVP.

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“…Overall, the results show that ultrasound parameters (JPI in the present study and IVC diameter in other studies [ 9 , 14 ]) are not associated with hemodynamic parameters. This is reasonable, as clinical and laboratory parameters do not accurately predict the early stage of hemorrhagic shock, and these parameters have shown variable sensitivity in previous studies [ 5 , 6 ].…”

Section: Discussionsupporting

confidence: 48%

“…Ultrasonography is an alternative tool for the diagnosis of volume loss. Celik et al [ 14 ] found no significant associations between the IVC diameter or aorta diameter in trauma patients and clinical signs or laboratory tests. Furthermore, Juhl-Olsen et al [ 9 ] assessed blood donors and detected no significant relationships between the IVC diameter (measured using ultrasonography) and cardiac output or the hemodynamic response in the early hemorrhagic stages.…”

Section: Discussionmentioning

confidence: 99%

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The role of internal jugular vein Doppler ultrasonography in predicting hypovolemic shock in polytrauma patients

Khajehpour

Behzadnia

2022

Ultrasonography

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Purpose: The purpose of this study was to evaluate the accuracy of the internal jugular vein (IJV) Doppler ultrasound in prediction of hypovolemic shock in polytrauma patients.Methods: This prospective observational study was conducted on 75 multiple trauma patients (injury severity score > 15) with a mean age of 33.00 ± 9.57. IJV Doppler ultrasound was performed for all patients with stable vital signs and negative extended focused assessment with sonography for trauma. Jugular pulsatility index (JPI) values were calculated using the equation (Vmax -Vmin)/Vmax. Clinical and laboratory indices of hypovolemic shock were recorded at the time of admission. Patients were subsequently divided into two groups: those with hemorrhagic shock (n = 36) and those without (n = 39) based on the occurrence of hemorrhagic shock within 6 hours after admission. Finally, the results were compared.Results: IJV Doppler ultrasound parameters (JPI, V-min, and Vmax -Vmin) indicated significant differences between the two groups. The JPI values of patients with hemorrhagic shock were significantly lower than those in the control group (0.43 ± 0.21 vs. 0.78 ± 0.24, P <0.0001). The sensitivity, specificity, and discriminant ability of JPI in detecting hemorrhagic shock were 86.11% and 82.05% (AUC = 0.853, P <0.0001), respectively. Conclusion:IJV Doppler evaluations can reliably predict hemorrhagic shock in polytrauma patients with stable vital signs. Ultrasound can be used in combination with clinical signs and laboratory findings to diagnose patients at risk of hypovolemic shock.

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Initial inferior vena cava and aorta diameter parameters measured by ultrasonography or computed tomography does not correlate with vital signs, hemorrhage or shock markers in trauma patients

Abstract: The value of an initial and single measurement of IVC and aorta parameters in the evaluation of trauma patients should be questioned. However, the change in the measured parameters may be of value and should be investigated in further studies.

Cited by 4 publications

References 20 publications

Ultrasonographic inferior vena cava diameter response to trauma resuscitation after 1 hour predicts 24-hour fluid requirement

Ultrasonographic inferior vena cava diameter response to trauma resuscitation after 1 hour predicts 24-hour fluid requirement

Inferior Vena Cava Dispensability Index versus Central Venous Pressure in Volume Status Assessment in Shocked Patients

The role of internal jugular vein Doppler ultrasonography in predicting hypovolemic shock in polytrauma patients

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