Correlation between Central Venous Pressure and Inferior Vena Cava Sonographic Diameter; Determining the Best Anatomic Location
Archives of Academic Emergency Medicine,
Vol. 4 No. 2 (2016),
1 May 2016
,
Page 83-87
https://doi.org/10.22037/aaem.v4i2.225
Abstract
Introduction: The correlation of central venous pressure (CVP) with inferior vena cava (IVC) sonographic diameter has been reported in several studies. However, few studies have attempted to find the best anatomic location of measurement. Therefore, the purpose of this study was determining the best anatomic location to find precise correlation between CVP and IVC diameter using transesophageal echocardiography (TEE). Methods: In the present diagnostic accuracy study, patients in need of central venous catheterization and TEE were enrolled. Maximum diameter of IVC were measured during expiratory phase of respiratory cycle at the level of diaphragm, 2cm above the diaphragm and at the point of entry into the right atrium using SonoSite TEE device. CVP was measured using an electronic transducer connected to the central venous line. The best location for sonography was determined via calculating and comparing area under the receiver operating characteristics (ROC) curve (AUC). Results: 39 patients were enrolled (53.8% female). Mean CVP was 6.8 ± 1.4 mmHg and 25 (64.1%) patients had normal CVP, while 14 (35.9%) showed elevated CVP (> 6 mmHg). Evaluating AUC showed that IVC diameter (p = 0.01), aorta diameter (p = 0.01) and IVC / aorta ratio (p = 0.004) had acceptable correlation with CVP. Point of entry of IVC into the right atrium with AUC of 0.98 (95% CI: 0.95 – 1.00) was the location of highest correlation with CVP. Conclusion: Based on the present findings, the IVC sonographic diameter and IVC / aorta ratio had acceptable correlation with CVP at the level of IVC entry into the right atrium.- Central venous pressure
- vena cava
- inferior
- aorta
- thoracic
- echocardiography
- transesophageal
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References
Thanakitcharu P, Charoenwut M, Siriwiwatanakul N. Inferior vena cava diameter and collapsibility index: a practical non-invasive evaluation of intravascular fluid volume in critically-ill patients. J Med Assoc Thai. 2013;96:S14-22.
Control CfD, Prevention. Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. Pediatrics. 2004;114(2):507.
Riccardi A, Chiarbonello B, Minuto P, Guiddo G, Corti L, Lerza R. Identification of the hydration state in emergency patients: correlation between caval index and BUN/creatinine ratio. Eur Rev Med Pharmacol Sci. 2013;17(13):1800-3.
Gorelick MH, Shaw KN, Murphy KO. Validity and reliability of clinical signs in the diagnosis of dehydration in children. Pediatrics. 1997;99(5):E6.
Pershad J, Myers S, Plouman C, et al. Bedside limited echocardiography by the emergency physician is accurate during evaluation of the critically ill patient. Pediatrics. 2004;114(6):e667-71.
Marcelino P, Fernandes A, Marum S, Ribeiro J. Non-invasive evaluation of central venous pressure by echocardiography. Rev Port Cardiol. 2002;21(2):125-33.
Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368-77.
Gong P, Huang X-E, Chen C-Y, Liu J-H, Meng A-F, Feng J-F. Comparison of complications of peripherally inserted central catheters with ultrasound guidance or conventional methods in cancer patients. Asian Pac J Cancer Prev. 2012;13(5):1873-5.
Jardim JM, Lacerda RA, Soares NdJD, Nunes BK. Evaluation of practices for the prevention and control of bloodstream infections in a government hospital. Rev Esc Enferm USP. 2013;47(1):38-45.
Kaye C, Smith D. Complications of central venous cannulation. BMJ. 1988;297(6648):572-3.
McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med. 2003;348(12):1123-33.
Pivalizza EG, Gumbert SD, Marasigan B, Guzman-Reyes S. 'Evidence'for practice guidelines for central venous access? Anesthesiology. 2012;117(4):916-7.
Chen L, Kim Y, Santucci KA. Use of ultrasound measurement of the inferior vena cava diameter as an objective tool in the assessment of children with clinical dehydration. Acad Emerg Med. 2007;14(10):841-5.
Chen L, Hsiao A, Langhan M, Riera A, Santucci KA. Use of bedside ultrasound to assess degree of dehydration in children with gastroenteritis. Acad Emerg Med. 2010;17(10):1042-7.
Bailey JK, McCall J, Smith S, Kagan RJ. Correlation of internal jugular vein/common carotid artery ratio to central venous pressure: a pilot study in pediatric burn patients. J Burn Care Res. 2012;33(1):89-92.
Arthur ME, Landolfo C, Wade M, Castresana MR. Inferior vena cava diameter (IVCD) measured with transesophageal echocardiography (TEE) can be used to derive the central venous pressure (CVP) in anesthetized mechanically ventilated patients. Echocardiography. 2009;26(2):140-9.
Donahue SP, Wood JP, Patel BM, Quinn JV. Correlation of sonographic measurements of the internal jugular vein with central venous pressure. Am J Emerg Med. 2009;27(7):851-5.
Ely EW, Smith AC, Chiles C, et al. Radiologic determination of intravascular volume status using portable, digital chest radiography: a prospective investigation in 100 patients. Crit Care Med. 2001;29(8):1502-12.
Jeremias A, Brown D. Cardiac Intensive Care. 2 ed. Philadelphia: Elsevier Health Sciences; 2010. p. 384.
Zengin S, Al B, Genc S, et al. Role of inferior vena cava and right ventricular diameter in assessment of volume status: a comparative study: ultrasound and hypovolemia. Am J Emerg Med. 2013;31(5):763-7.
Wiwatworapan W, Ratanajaratroj N, Sookananchai B. Correlation between inferior vena cava diameter and central venous pressure in critically ill patients. J Med Assoc Thai. 2012;95(3):320-4.
Baumann UA, Marquis C, Stoupis C, Willenberg TA, Takala J, Jakob SM. Estimation of central venous pressure by ultrasound. Resuscitation. 2005;64(2):193-9.
De Lorenzo RA, Morris MJ, Williams JB, et al. Does a simple bedside sonographic measurement of the inferior vena cava correlate to central venous pressure? J Emerg Med. 2012;42(4):429-36.
Goldflam K, Saul T, Lewiss R. Focus On: Inferior Vena Cava Ultrasound. ACEP News. 2011;6:24-5.
Nagdev AD, Merchant RC, Tirado-Gonzalez A, Sisson CA, Murphy MC. Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure. Ann Emerg Med. 2010;55(3):290-5.
Sridhar H, Mangalore P, Chandrasekaran V, Manikam R. Caval Aorta Index and Central Venous Pressure Correlation in Assessing Fluid Status!“Ultrasound Bridging the Gapâ€. ISRN Emerg Med. 2012;2012:1-5.
Tayal V, Blaivas M. American College of Emergency Physicians: ACEP emergency ultrasound guidelines-2001. Ann Emerg Med. 2009;53:470-81.
Blehar DJ, Dickman E, Gaspari R. Identification of congestive heart failure via respiratory variation of inferior vena cava diameter. Am J Emerg Med. 2009;27(1):71-5.
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