Bedside Sonographic Assessment of Intravascular Volume Status in the Surgical Intensive Care Unit: Is Subclavian Vein Collapsibility Equivalent to Inferior Vena Cava Collapsibility?

Abstract Purpose The role of diameter and collapse index of inferior vena cava (DCIIVC) in reflecting intravascular volume status and fluid responsiveness remains unclear. We aimed to evaluate the effectiveness of DCIIVC as a clinical indicator for fluid resuscitation (FR) in critically ill hypotensive patients.Methods This retrospective study enrolled hypotensive patients admitted to the surgical intensive care unit (SICU) between May 2018 and April 2019. Between May and October 2018, fluid therapy was conducted by a physician’s decision (non-DCIIVC group, 32 patients). Between November 2018 and April 2019, DCIIVC was used as a guide (DCIIVC group, 30 patients). Clinical outcomes of the two periods were compared.Results Total amount of fluid intake (TAFI) of non-DCIIVC and DCIIVC group in 24 h was 4,130 and 3,560, respectively (p < 0.05). TAFI in 48 h was 8,420 and 6,910, respectively (p < 0.01). Lactate levels at admission, 24 and 48 h after admission were 4.1 vs 3.8, 3.2 vs 3.1, and 1.9 vs 2.1 mmol/L, respectively. Mean duration of mechanical ventilation, ICU stay, and hospital stay were 4.1 vs 4.5, 7.2 vs 6.3, and 18.1 vs 17.2, respectively. Overall mortality was 16.7% vs 13.3%. There was no significant difference in any other characteristic except TAFI.Conclusion DCIIVC can be used as a tool for indicating FR in critically ill hypotensive patients. This can help physicians infuse fluid restrictively, without adverse outcomes.

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MEASUREMENT OF INFERIOR VENA CAVA DIAMETER BY ULTRASOUND IN INTENSIVE CARE UNIT PATIENTS WITH PNEUMONIA

Al-Azhar Medical Journal ◽

10.21608/amj.2022.212655 ◽

2022 ◽

Vol 51 (1) ◽

pp. 635-646

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Inferior Vena Cava ◽

Inferior Vena ◽

Vena Cava ◽

Inferior Vena Cava Diameter

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Prophylactic Inferior Vena Cava Filter Insertion for Trauma: Intensive Care Unit versus Operating Room

The American Surgeon ◽

10.1177/000313480607200303 ◽

2006 ◽

Vol 72 (3) ◽

pp. 213-216 ◽

Cited By ~ 2

Author(s):

Richard P. Gonzalez ◽

Mabelle Cohen ◽

Patrick Bosarge ◽

Jeffrey Ryan ◽

Charles Rodning

Keyword(s):

Intensive Care Unit ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Intensive Care ◽

Head Injury ◽

Inferior Vena Cava ◽

Operating Room ◽

Inferior Vena ◽

Vena Cava ◽

Cord Injury

The frequency of insertion of prophylactic inferior vena cava filters (IVCF) among traumatized patients has increased nationally. That has placed a substantial operational and economic burden upon trauma centers. The purpose of this study was to compare and contrast successful implantation, morbidity, and cost-effectiveness of prophylactic IVCF insertion in a surgical-trauma intensive care unit (STICU) versus an operating room (OR). A retrospective chart review was conducted of all trauma patients who received a prophylactic IVCF at an urban Level I trauma center between January 1999 and December 2003. Data were collected to identify patient demographics, indications, anatomical site of insertion, hospital location of insertion, hospital days before insertion, and complications associated with insertion. One hundred thirty-four patients underwent prophylactic IVCF during the study period: seventy-eight (58%) in the OR and fifty-six (42%) in the STICU. The average age of patients for the OR and STICU groups were 38.6 years and 39.6 years, respectively. The average number of days to IVCF insertion was 6.5 days and 7.0 days in the OR and STICU groups, respectively. Indications for IVCF among patients who had placement in the OR were orthopedic injury (60%), spinal cord injury (25%), and head injury (15%). Indications for IVCF among patients who had placement in the STICU were head injury (38%), orthopedic injuries (34%), and spinal cord injury (25%). Three (3.8%) patients in the OR group and two (3.6%) patients in the STICU group required a change of anatomic insertion site from the femoral to the internal jugular vein. There were two (2.6%) complications associated with IVCF insertion in the OR and two (3.5%) complications associated with IVCF insertion in the STICU (P > 0.05). Insertion of IVCF in the STICU decreased patient-cost by an average of $1636 per patient. Prophylactic IVCF insertion in an STICU is cost-effective and can be performed with similar success and complication rates to IVCF insertion in an OR.

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