Predictive Value of a Flat Inferior Vena Cava on Initial Computed Tomography for Hemodynamic Deterioration in Patients With Blunt Torso Trauma

Matsumoto, Shokei; Sekine, Keitaro; Yamazaki, Megumi; Sasao, Kenihiro; Funabiki, Takuzo; Shimizu, Masayuki; Yoshii, Hiroshi; Kishikawa, Masanobu; Kitano, Mitsuhide

doi:10.1097/ta.0b013e3181fc406f

Cited by 27 publications

(34 citation statements)

References 14 publications

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“…Second, a separate cohort of patients was not used to identify the optimal cutoff for defining a flat IVC thereby potentially limiting the strength of our conclusions. However, the cutoff value identified is consistent with the results of previous studies, which have attempted to predict mortality or hemodynamic deterioration in trauma patients with a flat IVC [7,8].…”

Section: Discussionsupporting

confidence: 85%

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Flat or fat? Inferior vena cava ratio is a marker for occult shock in trauma patients

Nguyen

Plurad

Bricker

et al. 2014

Journal of Surgical Research

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Section: Discussionsupporting

confidence: 85%

“…IVC transverse and anteroposterior diameters were measured 2.5e5 mm above the left renal vein on axial tomographic views. A flat IVC was defined as a transverse-toanteroposterior ratio !2.5 at the level of the suprarenal IVC [7,8]. A fat IVC was defined as a transverse-to-anteroposterior ratio of <2.5.…”

Section: 3mentioning

confidence: 99%

Flat or fat? Inferior vena cava ratio is a marker for occult shock in trauma patients

Nguyen

Plurad

Bricker

et al. 2014

Journal of Surgical Research

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“…Coagulation studies, such as the fibrin, fibrinogen degradation products and international normalized ratio of prothrombin time (PT-INR) were carried out in the central laboratory. Positive findings on ultrasonography or computed tomography (CT) scans, i.e., fluid collection on focused assessment with sonography for trauma (FAST positive) and the maximal transverse to anteroposterior ratio (the flat ratio 10 ) of the inferior vena cava (IVC) at the level of the renal vein on CT, were examined. These were considered as the data according to the secondary survey.…”

Section: Parametersmentioning

confidence: 99%

“…In addition, more than 90% of severe trauma patients have been reported to be injured by blunt mechanisms in Japan. 4 Various factors, such as the findings on physical examination, 5,6 metabolic markers, 7,8 coagulation products, 9 and radiographic assessments, 10 have been proposed to recognize trauma patients who are in a hypoperfusion state and thus need an MT. However, the most important predictor of the necessity of an MT among these variables has yet to be determined.…”

Section: Introductionmentioning

confidence: 99%

“…10,[20][21][22] Mirvis et al 21 noted that a flattened IVC was found in 10 of 13 patients who were clinically in a shock state after trauma. Matsumoto et al 10 showed that patients with a flat IVC on the initial CT scan in cases of blunt torso trauma showed hemodynamic deterioration, thus necessitating early blood transfusion and therapeutic intervention. In our study, the flat ratio of IVC on CT was one of the most significant variables for predicting the need for an MT, and it greatly improved the predictive reliability.…”

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confidence: 99%

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A simple predictive formula for the blood requirement in patients with high‐energy blunt injuries transferred within one hour post‐trauma

Akasaki

Sugimori

Momii

et al. 2014

Acute Medicine & Surgery

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Aims: To recognize patients who require massive transfusion at the early stage of blunt trauma, we retrospectively investigated patients with high-energy blunt injuries transferred within 1 h post-trauma. Methods:Between August 2007 and July 2011, 233 trauma patients were: (i) injured by a high-energy blunt mechanism with Injury Severity Score ≥9; (ii) not dead on arrival; (iii) older than 9 years; and (iv) at our center within 1 h after injury. The findings for 113 of those patients were analyzed, including those produced by ultrasonography, computed tomography, and arterial blood gas analyses.Results: Of 113 patients, 33 underwent massive transfusion (≥6 units) within 8 h of arrival. A logistic regression analysis revealed that an arterial lactate level ≥28 mg/dL (P < 0.001; odds ratio, 105.11; 95% confidence interval, 12.58-2,718.84) and a flat ratio of the inferior vena cava on computed tomography ≥3 (P < 0.001; odds ratio, 32.50; 95% confidence interval, 4.44-714.44) were significant independent predictors for a massive transfusion within 8 h. In a receiver operating curve analysis, the area under the curve of the need for massive transfusion was 0.956, with a sensitivity of 0.94 and a specificity of 0.90. A linear predictive formula for the probability (P) of receiving a massive transfusion was generated as P = 2 × lactate (mg/dL) + 15 × the flat ratio of inferior vena cava − 103. Using another 52 trauma patients, the formula was validated.Conclusions: An elevated level of arterial lactate and the flat ratio of inferior vena cava were significant predictors for identifying the patients who would require a massive transfusion in the early stage after high-energy blunt trauma.

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Rapid collapse of the inferior vena cava in a patient with cardiac arrest induced by anaphylactic shock after iodinated contrast medium injection

2020

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Anaphylactic shock to contrast media can progress to cardiac arrest despite appropriate treatment. During anaphylactic shock to contrast media, rapid vasodilation and a massive fluid shift can occur. Here we report a patient who developed cardiac arrest induced by anaphylactic shock to iodinated contrast medium and exhibited rapid collapse of the inferior vena cava (IVC) on enhanced abdominal computed tomography (CT) images. The patient underwent postsurgical unenhanced and contrast‐enhanced abdominal CT follow‐up of cecum cancer. She had neither allergy nor medical history except for the cancer. She did not complain of any symptoms immediately after completion of the CT. However, she developed anaphylactic shock and pulseless electrical activity cardiac arrest only 2 minutes after finishing the CT despite appropriate treatment. Emergency physicians successfully treated the patient using advanced life support and targeted temperature management. She recovered with good overall and cerebral performance (Overall Performance Category (OPC) 1 and Cerebral Performance Category (CPC) 1). On the contrast‐enhanced CT images, she exhibited rapid collapse of the IVC, although it was normal on the unenhanced CT images. The collapsed IVC is a good indicator of hypovolemia in patients with trauma. In this case, we considered that rapid vasodilation and a massive volume shift might have caused the collapsed IVC. This finding suggests the importance of aggressive volume resuscitation as well as epinephrine injection in patients with anaphylactic shock to contrast media. Furthermore, this finding occurred before the onset of clinical symptoms, and there is a possibility that it could be used as an indicator of anaphylactic shock to contrast media.

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Predictive Value of a Flat Inferior Vena Cava on Initial Computed Tomography for Hemodynamic Deterioration in Patients With Blunt Torso Trauma

Abstract: In cases of blunt torso trauma, patients with FVC on initial CT may exhibit hemodynamic deterioration, necessitating early blood transfusion and therapeutic intervention.

Cited by 27 publications

References 14 publications

Flat or fat? Inferior vena cava ratio is a marker for occult shock in trauma patients

Flat or fat? Inferior vena cava ratio is a marker for occult shock in trauma patients

A simple predictive formula for the blood requirement in patients with high‐energy blunt injuries transferred within one hour post‐trauma

Rapid collapse of the inferior vena cava in a patient with cardiac arrest induced by anaphylactic shock after iodinated contrast medium injection

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