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Bedside sonographic measurement of the inferior vena cava caval index is a poor predictor of fluid responsiveness in emergency department patients
Author(s) -
Corl Keith,
Napoli Anthony M,
Gardiner Fenwick
Publication year - 2012
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/j.1742-6723.2012.01596.x
Subject(s) - medicine , inferior vena cava , preload , hypovolemia , receiver operating characteristic , cardiac index , supine position , emergency department , cardiology , prospective cohort study , intravascular volume status , central venous pressure , cardiac output , nuclear medicine , hemodynamics , surgery , blood pressure , psychiatry , heart rate
Objectives Sonographic measurement of the inferior vena cava ( IVC ) caval index predicts central venous pressure in ED patients. Fluid responsiveness ( FR ) is a measure of preload dependence defined as an increase in cardiac output secondary to volume expansion. We sought to determine if the caval index is an accurate measurement of FR in ED patients. Methods We conducted a prospective, observational trial at an urban, academic, adult ED with an annual census >105 000. Included patients were clinically suspected of eu‐ and hypovolemia. Excluded patients were <18 years old, pregnant, incarcerated, sustained significant trauma or unable to consent. Supine IVC diameter was measured by bedside ultrasonography ( M ‐ T urbo; S onosite, B othwell, WA , USA ). Caval index = [(expiratory IVC diameter − inspiratory IVC diameter)/expiratory IVC diameter] × 100. FR was defined as an increase in the cardiac index by >10% by impedance cardiography ( BioZ ; S onosite) following passive leg raise. The primary outcome was analysed using S pearman correlations for non‐parametric data and the area under the receiver operating characteristics curve by W ilcoxon method. Results Thirty patients were enrolled; four were excluded because of incomplete data collection. Thirty‐one per cent (95% CI 13–48) of the patients were FR . The mean initial caval and cardiac index were 15.8% (95% CI 9.5–22) and 2.9 L/min/m 2 (95% CI 2.6–3.2), respectively. Caval index did not predict FR (receiver operating curve = 0.46, 95% CI 0.21–0.71, P = 0.63). Conclusion Bedside sonographic measurement of IVC caval index does not predict FR in a heterogeneous ED patient population. Further research using this technique in targeted patient subsets and a variety of shock etiologies is needed.