Automated Volume Status Assessment Using Inferior Vena Cava Pulsatility

Assessment of volume status is important to correctly plan the treatment of patients admitted and managed by cardiology, emergency and internal medicine departments. Non-invasive assessment of volume status by echography of the inferior vena cava (IVC) is a promising possibility, but its clinical use is limited by poor reproducibility of current standard procedures. We have developed new algorithms to extract reliable information from non-invasive IVC monitoring by ultrasound (US) imaging. Both long and short axis US B-mode video-clips were taken from 50 patients, in either hypo-, eu-, or hyper-volemic conditions. The video-clips were processed to extract static and dynamic indexes characterizing the IVC behaviour. Different binary tree models (BTM) were developed to identify patient conditions on the basis of those indexes. The best classifier was a BTM using IVC pulsatility indexes as input features. Its accuracy (78.0% when tested with a leave-one-out approach) is superior to that achieved using indexes measured by the standard clinical method from M-mode US recordings. These results were obtained with patients in conditions of normal respiratory function and cardiac rhythm. Further studies are necessary to extend this approach to patients with more complex cardio-respiratory conditions.

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Inferior Vena Cava Collapsibility Index: A Precise Non-invasive Tool for Evaluation of Edema in Children with Nephrotic Syndrome.

10.21203/rs.3.rs-397289/v1 ◽

2021 ◽

Author(s):

Hanan El-Halaby ◽

Ashraf Bakr ◽

Mohamed El-Assmy ◽

Hussein Abdelaziz Abdalla ◽

Marwa Salem ◽

...

Keyword(s):

Nephrotic Syndrome ◽

Inferior Vena Cava ◽

Inferior Vena ◽

Vena Cava ◽

Fractional Excretion ◽

Volume Status ◽

Non Invasive ◽

Collapsibility Index ◽

Fractional Excretion Of Sodium ◽

Status Assessment

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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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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SAT-097-Non-invasive estimation of intravascular volume status in cirrhosis by dynamic size and collapsibility Indices of the inferior vena cava using bedside echocardiography

Journal of Hepatology ◽

10.1016/s0618-8278(19)31336-2 ◽

2019 ◽

Vol 70 (1) ◽

pp. e670-e671

Author(s):

Madhumita Premkumar ◽

Devaraja Rangegowda ◽

Kamal Kajal ◽

Jelen Khumuckham

Keyword(s):

Inferior Vena Cava ◽

Inferior Vena ◽

Vena Cava ◽

Volume Status ◽

Intravascular Volume ◽

Non Invasive ◽

Bedside Echocardiography ◽

Intravascular Volume Status

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Lung ultrasound for volume status assessment in chronic hemodialysis patients

Vojnosanitetski pregled ◽

10.2298/vsp180622167i ◽

2020 ◽

Vol 77 (9) ◽

pp. 943-949

Author(s):

Igor Ivanov ◽

Vladimir Veselinov ◽

Dejan Celic ◽

Jadranka Dejanovic ◽

Dusanka Obradovic ◽

...

Keyword(s):

Inferior Vena Cava ◽

Inferior Vena ◽

Lung Ultrasound ◽

Vena Cava ◽

Left Atrial Volume ◽

Left Ventricular ◽

Chronic Hemodialysis ◽

Volume Status ◽

Before And After ◽

Status Assessment

Backoground/Aim. Assessing volume status in chronic hemodialysis (HD) patients is difficult despite several techniques have been developed. The aim of this study was to demonstrate the adequacy and efficacy of lung ultrasound (LUS) and B line score (BLS) in the assessment of volume status in patients on HD in comparison to other techniques: ultrasonographic determination of inferior vena cava diameter (IVCD), echocardiography (ECHO) and B-type natriuretic peptide (BNP) determination. Methods. LUS, ECHO, ultrasonography of inferior vena cava in inspiration (IVCDi) and expiration (IVCDe), and BNP sampling were performed before and after HD in 83 patients. Results. A significant reduction of BLS, IVCDi, IVCDe, BNP and several ECHO parameters such as left atrium diameter (LA), left ventricular internal dimension in diastole and systole (LVIDd and LVIDs, respectively), and left atrial volume in systole (LAVs), was registered (p < 0.001). There was a significant correlation between BLS and BNP before (p = 0.01) and after HD (p = 0.05), and a weaker but significant correlation between BLS and IVCDi and IVCDe before HD (p = 0.05). Conclusion. All techniques assessed hypervolemia before and after HD successfully. BNP correlated with LUS before and after HD, and IVCDi and IVCDe correlated with LUS only before HD. LUS is cheap and simple to perform, can be performed bedside and can be reliably used for assessing volume status in HD patients.

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