scholarly journals Measuring the ratio of femoral vein diameter to femoral artery diameter by ultrasound to estimate volume status

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhihang Ma ◽  
Jiaxin Gai ◽  
Yinghan Sun ◽  
Yunpeng Bai ◽  
Hongyi Cai ◽  
...  
Keyword(s):  
Blood Volume ◽  
Femoral Artery ◽  
Roc Curve ◽  
Femoral Vein ◽  
Venous Pressure ◽  
Volume Status ◽  
Strongly Correlated ◽  
Central Venous ◽  
Test Characteristics ◽  
Vein Diameter

Abstract Background Currently, the accepted effective method for assessing blood volume status, such as measuring central venous pressure (CVP) and mean pulmonary artery pressure (mPAP), is invasive. The purpose of this study was to explore the feasibility and validity of the ratio of the femoral vein diameter (FVD) to the femoral artery diameter (FAD) for predicting CVP and mPAP and to calculate the cut-off value for the FVD/FAD ratio to help judge a patient’s fluid volume status. Methods In this study, 130 patients were divided into two groups: in group A, the FVD, FAD, and CVP were measured, and in group B, the FVD, FAD, and mPAP were measured. We measured the FVD and FAD by ultrasound. We monitored CVP by a central venous catheter and mPAP by a Swan-Ganz floating catheter. Pearson correlation coefficients were calculated. The best cut-off value for the FVD/FAD ratio for predicting CVP and mPAP was obtained according to the receiver operating characteristic (ROC) curve. Results The FVD/FAD ratio was strongly correlated with CVP (R = 0.87, P < 0.0000) and mPAP (R = 0.73, P < 0.0000). According to the ROC curve, an FVD/FAD ratio ≥ 1.495 had the best test characteristics to predict a CVP ≥ 12 cmH2O, and an FVD/FAD ratio ≤ 1.467 had the best test characteristics to predict a CVP ≤ 10 cmH2O. An FVD/FAD ratio ≥ 2.03 had the best test characteristics to predict an mPAP ≥ 25 mmHg. According to the simple linear regression curve of the FVD/FAD ratio and CVP, when the predicted CVP ≤ 5 cmH2O, the FVD/FAD ratio was ≤ 0.854. Conclusion In this study, the measurement of the FVD/FAD ratio obtained via ultrasound was strongly correlated with CVP and mPAP, providing a non-invasive method for quickly and reliably assessing blood volume status and providing good clinical support.

scholarly journals Should we stop using the determination of central venous pressure as a way to estimate cardiac preload?

2012 ◽  
pp. 181-184 ◽  
Author(s):  
Johann Smith Ceron Arias ◽  
Manuel Felipe Muñoz Nañez
Keyword(s):  
Central Venous Pressure ◽  
Blood Volume ◽  
Pulse Pressure ◽  
Venous Pressure ◽  
Pressure Change ◽  
Cardiac Preload ◽  
Central Venous ◽  
End Diastolic Volume ◽  
Dynamic Variables

The determination of the values of central venous pressure has long been used as a guideline for volumetric therapy in the resuscitation of the critical patient, but the performance of such parameter is currently being questioned as an effective measurement of cardiac preload. This has aroused great interest in the search for more accurate parameters to determine cardiac preload and a patient’s blood volume. Goals and Methodology: Based on literature currently available, we aim to discuss the performance of central venous pressure as an effective parameter to determine cardiac preload. Results and Conclusion: Estimating variables such as end-diastolic ventricular area and global end-diastolic volume have a better performance than central venous pressure in determining cardiac preload. Despite the best performance of these devices, central venous pressure is still considered in our setting as the most practical and most commonly available way to assess the patient’s preload. Only dynamic variables such as pulse pressure change are superior in determining an individual’s blood volume.

Contribution of abdomen and legs to central blood volume expansion in humans during immersion

1997 ◽  
Vol 83 (3) ◽  
pp. 695-699 ◽  
Author(s):  
Lars Bo Johansen ◽  
Thomas Ulrik Skram Jensen ◽  
Bettina Pump ◽  
Peter Norsk
Keyword(s):  
Blood Volume ◽  
Volume Expansion ◽  
Protein Concentration ◽  
Water Immersion ◽  
Venous Pressure ◽  
Cuff Inflation ◽  
Central Blood Volume ◽  
Central Venous ◽  
Plasma Protein Concentration ◽  
Blood Volume Expansion

Johansen, Lars Bo, Thomas Ulrik Skram Jensen, Bettina Pump, and Peter Norsk. Contribution of abdomen and legs to central blood volume expansion in humans during immersion. J. Appl. Physiol. 83(3): 695–699, 1997.—The hypothesis was tested that the abdominal area constitutes an important reservoir for central blood volume expansion (CBVE) during water immersion in humans. Six men underwent 1) water immersion for 30 min (WI), 2) water immersion for 30 min with thigh cuff inflation (250 mmHg) during initial 15 min to exclude legs from contributing to CBVE (WI+Occl), and 3) a seated nonimmersed control with 15 min of thigh cuff inflation (Occl). Plasma protein concentration and hematocrit decreased from 68 ± 1 to 64 ± 1 g/l and from 46.7 ± 0.3 to 45.5 ± 0.4% ( P < 0.05), respectively, during WI but were unchanged during WI+Occl. Left atrial diameter increased from 27 ± 2 to 36 ± 1 mm ( P < 0.05) during WI and increased similarly during WI+Occl from 27 ± 2 to 35 ± 1 mm ( P < 0.05). Central venous pressure increased from −3.7 ± 1.0 to 10.4 ± 0.8 mmHg during WI ( P < 0.05) but only increased to 7.0 ± 0.8 mmHg during WI+Occl ( P < 0.05). In conclusion, the dilution of blood induced by WI to the neck is caused by fluid from the legs, whereas the CBVE is caused mainly by blood from the abdomen.

scholarly journals Measurement of Inferior Ven Cava Collapsibility Index and Its Correlation to Central Venous Pressure in Adult Critically Ill Patients a Prospective Observational Study

2020 ◽  
Vol 5 (1) ◽  
Keyword(s):  
Inferior Vena Cava ◽  
Central Venous Pressure ◽  
Inferior Vena ◽  
Venous Pressure ◽  
Vena Cava ◽  
Volume Status ◽  
P Value ◽  
Central Venous ◽  
Collapsibility Index ◽  
Status Assessment

Fluid therapy is an essential component part management of critically ill patients. Proper estimation of the amount of needed fluids is of great importance due to the well-established adverse effects of marked negative and positive fluids balance. Central venous pressure has been widely used by ICU physicians for volume status assessment. Several methods have been postulated for volume status assessment, among which is the inferior vena cava collapsibility index. As the inferior vena cava is a thin-walled capacitance vessel that adjusts to the body’s volume status by changing its diameter depending on the total body fluid volume. Giving the fact that bed-side ultrasonographic measurement of inferior vena cava diameters is an available, non-invasive, reproducible and quiet easy-to-learn technique, it can provide a safe and quiet reliable replacement of central venous pressure measurement for assessment of volume status assessment. The aim of this study was to find statistical correlation between central venous pressure and caval index, as a step towards validating the above mentioned replacement. 86 critically ill patients from ICU population were enrolled. Simultaneous measurements of central venous pressure and inferior vena cava collapsibility index were observed and recorded on four sessions. Patients were also grouped based on their mode of ventilation and central venous pressure values in order to compare the strength of correlation between various populations. The results showed that Inferior vena cava collapsibility index has significant inverse correlation with CVP value (r= -85, p value ˂0.001 at 95% CI) and it better correlated with mean arterial blood pressure and lactate clearance as compared to central venous pressure. However it correlated better with CVP in spontaneously breathing patients (r= -0.86, p value ˂0.001) than in mechanically ventilated patients (r= -0.84, p value ˂0.001). Inferior vena cava collapsibility index has shown to correlate better with CVP value in lower values (˂ 10 cmH2O) (r= -0.8, p value ˂0.001) than in higher values (≥ 10 cmH2O) (r= -0.6, p value ˂0.001). In addition, an inferior vena caval collapsibility index cut-off value of 29% was shown to discriminate between CVP values ˂10 cmH2O and values ≥10 cmH2O with high Sensitivity (88.6%) and specificity (80.4%). In conclusion, inferior vena cava collapsibility index has a strong inverse relationship with central venous pressure which is more pronounced at low central venous pressure values. Point-of-care ultrasonographically-measured inferior vena cava collapsibility index is very likely to be a good alternative to central venous pressure measurement with a high degree of precision and reproducibility. However, Wide scale studies are needed to validate its use in different patient populations.

A PROSPECTIVE OBSERVATIONAL STUDY TO ASSESS CORRELATION OF CAVAL AORTA INDEX WITH CENTRAL VENOUS PRESSURE FOR INTRAVASCULAR VOLUME ASSESSMENT IN PATIENTS UNDERGOING ENDOSCOPIC TRANSURETHERAL RESECTION OF PROSTATE (TURP)

2021 ◽  
pp. 10-12
Author(s):  
N. Senthil kumar ◽  
Jeya Pratheef Muthiah
Keyword(s):  
Prospective Observational Study ◽  
Inferior Vena ◽  
Venous Pressure ◽  
Vena Cava ◽  
Volume Status ◽  
Intravascular Volume ◽  
Central Venous ◽  
Sonographic Evaluation ◽  
Volume Assessment ◽  
The Mean

INTRODUCTION: There are various techniques for assessing the uid status such as clinical examination, central venous pressure (CVP) measurement, biochemical markers, bio impedance, continuous blood volume measurement, or sonographic inferior vena cava (IVC) diameter assessment. Sonographic evaluation of the IVC and Aorta diameter and its usefulness in evaluating the volume status are studied and documented. The sonographic evaluation of the IVC & Aorta can predict the volume status, this tool can assist anesthetist in rapid diagnosis and prompt resuscitation of patients developing TURP syndrome AIM OF THE STUDY: The aim & objective of this study is to assess the correlation of Caval Aorta index with CVP in intravascular volume assessment in patients undergoing endoscopic Trans Urethral Resection of Prostate (TURP) MATERIALS AND METHODS: The study is carried out in the Department of Anaesthesiology involving Department of Urology in Kanyakumari Government Medical College from January 2018 to June 2019. It is a Prospective observational study. To measure the IVC diameter USG machine probe is placed in the sub-xiphoid region to visualize the conuence of the hepatic veins draining the IVC. The maximum internal AP diameter of the Aorta(Ao) and maximum internal anterior-posterior (AP) diameter of the IVC is measured in the longitudinal plane. Fluid status will be measured by CVP and IVC/Ao index recorded before neuraxial block, after preload, at 5 min after intrathecal block, resection time at 0 min, every 15 min during the rst 30 min, then every 30 min, until the end of surgery. Outcome: Incidence of hypotension after spinal anesthesia in a cesarean section RESULTS: The mean IVC diameter at pre-operative is 15.20±1.42, and at 60 min, 75 min were 19.39±1.92, 20.03±1.76 which suggests that the size and shape of the inferior vena cava (IVC) is correlated to the CVP and circulating blood volume. In my study the mean Aortic diameter at 60 min, 75 min were 20.30±1.01 and 19.81±1.06 which is same as the preoperative level (19.72±1.18) and diameter. The mean CVP at pre-operative is 4.57±0.73, mean CVP at 60 min, 75 min were 7.57±0.82, 8.11±0.78 which denotes that CVP increases as the intravascular volume status increases. In our study mean IVC/Aortic index at pre-operative is 0.77±0.05 and the mean IVC/Aortic index at 15min, 30 min, 60 min, 75 min were 0.87±0.03, 0.90±0.04, 0.95±0.06, 1.01±0.05 which increases signicantly in increasing intravascular volume. The strong correlation between these two variable with Pearson formula ranging from 0.450-0.900. CONCLUSION: As Sonographic caval Ao index is very well correlated with CVP , IVC/Ao index is useful for the evaluation of preoperative and intraoperative volume status, especially in major surgeries with marked uid shift or blood loss and had the advantage of being noninvasive, safe, quick, and easy technique with no complications.

Cardiorespiratory Status of Erythroblastotic Newborn Infants: III. Intravascular Pressures During the First Hours of Life

PEDIATRICS ◽  
1976 ◽  
Vol 58 (4) ◽  
pp. 484-493
Author(s):  
Roderic H. Phibbs ◽  
Paul Johnson ◽  
Joseph A. Kitterman ◽  
George A. Gregory ◽  
William H. Tooley ◽  
...  
Keyword(s):  
Central Venous Pressure ◽  
Blood Volume ◽  
High Pressures ◽  
Venous Pressure ◽  
Newborn Infants ◽  
Hydrops Fetalis ◽  
Central Venous ◽  
Myocardial Failure ◽  
Prematurely Born Infants

We measured aortic and central venous pressures beginning soon after birth in 40 prematurely born infants with moderate or severe erythroblastosis fetalis, including 13 with severe and 10 with mild hydrops fetalis. All but four were asphyxiated at birth and this affected intravascular pressures. Before resuscitation, aortic or central venous pressure or both were elevated in more than one third. All but two of the remaining infants had normal initial pressures. Following resuscitation which relieved acidosis, hypoxia, and anemia, but did not reduce blood volume, the high pressures usually fell to normal and occasionally to subnormal levels, normal pressures fell to subnormal in almost one half, and those with initial subnormal pressures remained hypotensive. In all, 40% were hypotensive after resuscitation; treatment with blood volume expanders consistently returned these pressures to normal. Only two of the 13 severely hydropic infants and none of the mildly hydropic had findings indicative of hypervolemia and myocardial failure which persisted after treatment of asphyxia.

scholarly journals Reflex-Mediated Reduction in Human Cerebral Blood Volume

2005 ◽  
Vol 25 (1) ◽  
pp. 136-143 ◽  
Author(s):  
Timothy D Wilson ◽  
J Kevin Shoemaker ◽  
R Kozak ◽  
T-Y Lee ◽  
Adrian W Gelb
Keyword(s):  
Central Venous Pressure ◽  
Blood Volume ◽  
Cerebral Blood Volume ◽  
Lower Body Negative Pressure ◽  
Mean Transit Time ◽  
Venous Pressure ◽  
Cold Pressor Test ◽  
Cold Pressor ◽  
Lower Body ◽  
Central Venous

Adrenergic nerves innervate the human cerebrovasculature, yet the functional role of neurogenic influences on cerebral hemodynamics remains speculative. In the current study, regional cerebrovascular responses to sympathoexcitatory reflexes were evaluated. In eight volunteers, contrast-enhanced computed tomography was performed at baseline, –40 mmHg lower body negative pressure (LBNP), and a cold pressor test (CPT). Cerebral blood volume (CBV), mean transit time (MTT), and cerebral blood flow (CBF) were evaluated in cortical gray matter (GM), white matter (WM), and basal ganglia/thalamus (BGT) regions. Lower body negative pressure resulted in tachycardia and decreased central venous pressure while mean arterial pressure was maintained. Cold pressor test resulted in increased mean arterial pressure concomitant with tachycardia but no change in central venous pressure. Neither reflex altered end-tidal carbon dioxide. Cerebral blood volume was reduced in GM during both LBNP and CPT ( P<0.05) but was unchanged in WM and BGT. Mean transit time was reduced in WM and GM during CPT ( P<0.05). Cerebral blood flow was only modestly affected with either reflex ( P<0.07). The combined reductions in GM CBV (˜ –25%) and MTT, both with and without any change in central venous pressure, with small CBF changes (˜ –11%), suggest that active venoconstriction contributed to the volume changes. These data demonstrate that CBV is reduced during engagement of sympathoexcitatory reflexes and that these cerebrovascular changes are heterogeneously distributed.

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