A New Formula for Non-invasive Assessment of Intravascular Fluid Status with Inferior Vena Cava Diameters and Collapsibility Index: A Pilot Study

Abstract Evaluating the volume status in children with Idiopathic nephrotic syndrome (INS) is mandatory to guide treatment and avoid unnecessary possibly hazardous albumin use. This study aimed to evaluate and compare the available tools used for volume status assessment and differentiating type of edema in children with INS. Sixty children with active INS were included and subdivided into hypovolemic and non-hypovolemic groups based on fractional excretion of sodium (FeNa%) and clinical assessment. All patients were studied for Inferior vena cava collapsibility index (IVCCI), plasma atrial natriuretic peptide (ANP) concentration and Body composition monitor (BCM). Forty-four patients (77.3%) had non-hypovolemic and 16 (26.7%) had hypovolemic states. Plasma ANP levels didn’t differ between hypovolemic and non-hypovolemic subgroups. IVCCI was higher in hypovolemic group (p<0.001) with sensitivity 87.5% and specificity 81.8% for hypovolemia detection while BCM-over hydration (BCM-OH) values were higher in non-hypovolemic group (p=0.04) with sensitivity= 68.2% and specificity =75% for detection of hypervolemia. FeNa% showed negative significant correlation with IVCCI (r= -0.578, p <0.001) and positive significant correlation with BCM-OH (r= 0.33, p=0.018), while FeNa% showed non-significant correlation to plasma ANP concentration (p=0.25). Conclusion: Non-hypovolemic edema is more frequent in edematous INS children than hypovolemic states. IVCCI is a reliable non-invasive bedside tool for evaluating volume status in INS children and is superior to BCM while plasma ANP levels can’t discriminate type of edema in INS.

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Inferior vena cava collapsibility index as a predictor of fluid responsiveness in sepsis-related acute circulatory failure

Ain-Shams Journal of Anesthesiology ◽

10.1186/s42077-021-00194-y ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Ahmed Ibrahim Nagi ◽

Azza Mohamed Shafik ◽

Amr Mohamed Abdel Fatah ◽

Wessam Zaher Selima ◽

Amira Fathy Hefny

Keyword(s):

Inferior Vena Cava ◽

Fluid Responsiveness ◽

Volume Expansion ◽

Inferior Vena ◽

Vena Cava ◽

Circulatory Failure ◽

Acute Circulatory Failure ◽

Non Invasive ◽

Collapsibility Index ◽

Spontaneously Breathing

Abstract Background Assessing fluid responsiveness is the key to successful resuscitation of critically-ill sepsis patients. The use of IVC variation is favored among the dynamic methods of fluid responsiveness assessment in the ICU because it is non-invasive and inexpensive; moreover, it does not demand a high level of training. The aim of this study is to determine the value of the IVC respiratory variability for predicting fluid responsiveness in spontaneously breathing sepsis patients with acute circulatory failure. Results In this prospective observational study, fifty-eight spontaneously breathing sepsis patients admitted in the ICU were enrolled after the approval of the departmental Research Ethical Committee, and the informed written consent had been taken from the patients. Ultrasonographic and echocardiographic parameters were measured “IVC parameters and stroke volume (SV)” with calculation of the inferior vena cava collapsibility index (IVCCI) and cardiac output. These values were obtained before (baseline) and after volume expansion with a fluid bolus. The study showed that twenty-nine patients (50%) were considered to be responders, with an increase in CO by 10% or more after fluid challenge. There was a significant difference between responders and non-responders in baseline IVCCI (p value < 0.001). There were no significant differences between responders and non-responders in terms of demographic and baseline clinical characteristics. Also, there was statistically significantly larger maximum (IVC max) and minimum (IVC min) inferior vena cava diameters before volume expansion in non-responders than in responders with p value 0.037 and 0.001 respectively. The suggested cut off value regarding baseline IVCCI to predict response to fluid infusion is 0.32 with a high chance of response above this figure (a sensitivity of 72.41% and a specificity of 82.76%). Conclusions Inferior vena cava collapsibility index assessment can be a sensitive and a good predictor of fluid responsiveness, being based on a safe and a non-invasive technique compared to other methods such as central venous pressure (CVP) measurement and pulmonary artery catheter insertion.

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Inferior Vena Cava Collapsibility Index is a Valuable and Non-Invasive Index for Elevated General Heart End-Diastolic Volume Index Estimation in Septic Shock Patients

Medical Science Monitor ◽

10.12659/msm.897406 ◽

2016 ◽

Vol 22 ◽

pp. 3843-3848 ◽

Cited By ~ 6

Author(s):

Jie Zhao ◽

Guolin Wang

Keyword(s):

Septic Shock ◽

Inferior Vena Cava ◽

Inferior Vena ◽

Vena Cava ◽

Volume Index ◽

Non Invasive ◽

End Diastolic Volume ◽

Collapsibility Index ◽

Index Estimation

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Baseline Diameter of the Inferior Vena Cava Measured with Sonography in Euvolemic Children and its Relationship to Somatic Variables

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-1232-1217 ◽

2020 ◽

Author(s):

Tomas Zaoral ◽

Peter Kordos ◽

Marketa Nowakova ◽

Borek Travnicek ◽

Jana Zapletalova ◽

...

Keyword(s):

Inferior Vena Cava ◽

Prospective Observational Study ◽

Inferior Vena ◽

Pediatric Population ◽

Vena Cava ◽

Healthy Children ◽

Fluid Status ◽

Collapsibility Index ◽

Sick Children ◽

Baseline Diameter

Abstract Purpose To determine normative data for the inferior vena cava (VCI) diameter in euvolemic children and its correlation with different somatic parameters in a pediatric population at one center in Europe. Materials and Methods This prospective observational study enrolled healthy children aged 4 weeks to 18y that visited our outpatient clinic. Weight, height, body surface area, and age were recorded. The children were grouped according to weight, as follows (80 children/group): < 10 kg, 10–19.9 kg, 20–29.9 kg, 30–59.9 kg, and 60–90 kg. Children were placed in a supine position and, during quiet respiration, the maximum and minimum VCI diameters were measured with M-mode ultrasonography. The collapsibility index (CI) was also automatically calculated for each subject: CI = [VCI maximum (expiratory) diameter – VCI minimum (inspiratory) diameter]/VCI maximum (expiratory) diameter. Results From May 2016 through November 2018 we retrieved data for 415 children that underwent VCI diameter evaluations. 400 children were included (mean age: 7.8y ± 5.8, mean weight: 32 kg ± 24.4, 46 % girls). The VCImax and the VCImin were significantly correlated with age (r = 0.867, p < 0.001, r = 0.797, p < 0.001), height (r = 0.840, p < 0.001, r = 0.772, p < 0.001), weight (r = 0.858, p < 0.001, r = 0.809, p < 0.001), and BSA (r = 0.878, p < 0.001, r = 0.817, p < 0.001). Correlations between the CI and age, weight, height, and BSA were not statistically significant. Conclusion This prospective study provided reference values for sonographic measurements of VCI diameters in euvolemic children and might greatly assist in assessing fluid status in sick children.

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365 The influence of feeding regimens on non-invasive inferior vena cava and hepatic vein velocity measurements in infants

European Journal of Echocardiography ◽

10.1016/s1525-2167(99)80226-1 ◽

1999 ◽

Vol 1 ◽

pp. S64-S64

Author(s):

A OZYUREK ◽

Z KURUGOL ◽

C DORAK ◽

E LEVENT ◽

A EGEMEN ◽

...

Keyword(s):

Inferior Vena Cava ◽

Hepatic Vein ◽

Inferior Vena ◽

Vena Cava ◽

Velocity Measurements ◽

Non Invasive

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

Journal of Anesthesia & Pain Medicine ◽

10.33140/japm.05.01.09 ◽

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.

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