Abstract
Background
Ultrasonographic evaluation of the inferior vena cava (IVC) provides information on
central hemodynamics and predicts fluid responsiveness during positive pressure ventilation.
In spontaneously breathing patients, the correlations between IVC dynamics and the
hemodynamic response to volume shifts remain to be described.
Objectives
We aimed to describe the correlation between IVC dynamics and the changes in cardiac
output (CO) caused by controlled hemorrhage.
Methods
Healthy donors from the blood bank were eligible for inclusion. Measurements of the
IVC and CO were performed before and immediately after blood donation using ultrasound
methods. A control group served to evaluate the effect of resting.
Results
Thirty-seven participants completed the study. IVC collapsibility index (IVC-CI) and
IVC end expiratory diameter (IVCe) both changed significantly after blood donation
(p < 0.001). The baseline IVC-CI and IVCe did not correlate with the change in CO (p-values ≥ 0.40). The alterations in IVC-CI and IVCe induced by blood donation also
did not correlate with the change in CO (p ≥ 0.71). The sensitivities of IVC-CI or IVCe, defined as an increase in IVC-CI and
a decrease in IVCe, for picking up any decrease in CO were 81.3% and 84.4%, respectively.
In the control group, no effect was seen between measurements.
Conclusion
IVC-CI and IVCe did not correlate with the magnitude of hemodynamic response to early
hemorrhage. The sensitivity of serial IVC measurements was approximately 80% for detecting
early blood loss.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Handcarried ultrasound measurement of the inferior vena cava for assessment of intravascular volume status in the outpatient hemodialysis clinic.Clin J Am Soc Nephrol. 2006; 1: 749-753
- Inferior vena cava diameter correlates with invasive hemodynamic measures in mechanically ventilated intensive care unit patients with sepsis.J Emerg Med. 2010; 38: 632-637
- Comparison of serial qualitative and quantitative assessments of caval index and left ventricular systolic function during early fluid resuscitation of hypotensive emergency department patients.Acad Emerg Med. 2011; 18: 912-921
- Inferior vena cava diameter (IVCD) measured with transesophageal echocardiography (TEE) can be used to derive the central venous pressure (CVP) in anesthetized mechanically ventilated patients.Echocardiography. 2009; 26: 140-149
- Reappraisal of the use of inferior vena cava for estimating right atrial pressure.J Am Soc Echocardiogr. 2007; 20: 857-861
- Inferior vena cava diameter and central venous pressure correlation during cardiac surgery.J Cardiothorac Vasc Anesth. 2007; 21: 492-496
- Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients.Intensive Care Med. 2004; 30: 1740-1746
- The respiratory variation in inferior vena cava diameter as a guide to fluid therapy.Intensive Care Med. 2004; 30: 1834-1837
- Inferior vena cava distensibility as a predictor of fluid responsiveness in patients with subarachnoid hemorrhage.Neurocrit Care. 2010; 13: 3-9
- Comparative accuracy of Doppler echocardiographic methods for clinical stroke volume determination.Am Heart J. 1990; 120: 116-123
- Influence of increased abdominal pressure on steady-state cardiac performance.J Appl Physiol. 1999; 86: 1651-1656
- Ultrasound assessment of inferior vena cava collapsibility is not a valid measure of preload changes during triggered positive pressure ventilation: a controlled cross-over study.Ultraschall Med. 2012; 33: 152-159
- Sonographic measurement of the inferior vena cava as a marker of blood loss.Am J Emerg Med. 2005; 23: 45-50
- Ultrasound does not detect early blood loss in healthy volunteers donating blood.J Emerg Med. 2011; 41: 270-275
- Confirmation of the safety of autologous blood donation by patients awaiting heart or lung transplantation. A controlled study using hemodynamic monitoring.J Thorac Cardiovasc Surg. 1995; 110: 1594-1599
- Cardiovascular responses to phlebotomy and sitting in middle-aged and elderly subjects.Arch Intern Med. 1992; 152: 366-370
Article info
Publication history
Published online: July 22, 2013
Accepted:
March 15,
2013
Received in revised form:
January 31,
2013
Received:
August 28,
2012
Footnotes
Conflict of Interest: Erik Sloth has received fees for lectures from BK Medical and General Electrics. The other authors have no competing interests.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
