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The Most Useful Method To Evaluate The Volume Status Of Critical Patients In The Emergency And Intensive Care Units: Point Of Care Ultrasound

Year 2020, Volume: 10 Issue: 4, 474 - 480, 30.12.2020

Meltem İnce Metin Ocak

https://doi.org/10.16899/jcm.728902

Abstract

Background: Accurate and rapid assessment of intravascular volume status of the patients in emergency services and intensive care units at diagnosis, treatment and follow-up stages is crucial yet rather difficult. The purpose of hemodynamic monitoring is to determine cardiovascular insufficiency and to provide the most suitable treatment for unstable patients in critical condition.
Aim: The study aims to compare vena cava inferior diameter, vena cava inferior- collapsibility index (for spontaneously breathing patients) and vena cava inferior- distensibility index (for patients breathing on mechanical ventilation support) measurement by ultrasonography to central venous pressure measurement by placing invasive catheter for assessment of the intravascular volume status and making an accurate volume replacement in emergency service and intensive care units and to determine the correlation between them.
Material and Methods: The study was carried out prospectively on the patients above the age of 18 who applied to the emergency service clinic between the dates of 01.06.2014 and 01.04.2015 or who stayed in the emergency intensive care unit between these dates. Measurements were taken from vena cava inferior in both the inspirium and expirium phases by using M mode and they were recorded in millimeter. Simultaneous central venous pressure measurements were performed on the patients by using manometric devices and the results were recorded in cm H2O.
Results: 43.3% of the patients were female (n: 26) and 56.7% were male (n: 34), and the mean age is 70.58 ± 14.86. The study found high degree of positive correlation between central venous pressure and vena cava inferior diameters and high degree of negative correlation between vena cava inferior- collapsibility index . The study also found that there is a high degree of negative correlation between vena cava inferior- distensibility index and central venous pressure in patients receiving mechanical ventilatory support.
Conclusion: Measurement of respiratory variation in vena cava inferior diameter by using ultrasonography is a quick, reliable, easily applicable, cost-efficient and non-invasive method in critical patients receiving mechanical ventilatory support or have spontaneous respiration in emergency services and intensive care units and it can be useful in assessing the volume status and estimating central venous pressure.

Keywords

Central Venous Pressure Vena Cava Inferior Ultrasonography Volume Status

References

  • Zang Z, Xu X, S Ye, L Xu. Ultrasonographic measurement of the respiratory variation in the inferior vena cava diameter is predictive of volume responsiveness in critically ill patients: systematic review and meta-analysis. Ultrasaound Med. Biol. 2014;40(5):845-556
  • Rivers, E., Nguyen B., Havstad S.,Ressler J, Muzzın A, Knoblich B.; et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19): 368-77.
  • Duane, P.G. and G.L. Colice, Impact of noninvasive studies to distinguish volume overload from ARDS in acutely ill patients with pulmonary edema: analysis of the medical literature from 1966 to 1998. Chest. 2000;118(6): 1709-17
  • Mateer J., Plummer D., Heller M., Olson D., Jehle D., Overton D; et al. Model curriculum for physician training in emergency ultrasonography. Ann Emer Med. 1994; 23:95-102.
  • Plummer D. Whose turf is it, anyway? Diagnostic ultrasonography in the emergency department. Acad Emerg Med. 2007;7:186-187.
  • Mayron R, Gaudio FE, Plummer D, Asinger R, Elsperger J. Echocardiography performed by emergency physicians: Impact on diagnosis and therapy. Ann Emerg Med. 1988; 17: 150–154.
  • Kendall JL, Hoffenberg SR, Smith S. History of emergency and critical care ultrasound: The evolution of a new image paradigm. Crit Care Med. 2007; 35: 126-130
  • Prof. Dr. Şefik Güney ; Kolaylaştırılmış acil ultrason,Maltepe Üniversitesi Radyoloji A.B.D . 2010, 1. Edition
  • Kicher BJ, Himelman RB, Schiller NB. Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol. 1990; 66: 493–496.
  • Barbier C, LoubieresY, Schmit C, Hayon J, Ricome J-L, Jardin F,et all. Respiratory changes in inferior vena cava diamater are helpful in predicting fluid responsiveness in ventilated septic patients. İntensive Care Med 2004;30(9):1740-6
  • Wiedemann HP, Wheeler AP., Bernard G.R., Thompson B.T.,Hayden D., deBoisblanc B.et al National Heart, Lung, and Blood Institute Acute Respiratory Distress Synndrome(ARDS) Clincal Trials Network, Comparison of two volume-management strategies in acute lung injury. N Engl J Med.2006 ;354(24):2564-2575.
  • Levitov A.Mayo PH, Slonim AD. Critical Care Ultrasonography.1 st ed.New York , NY : McGraw-Hill Medical ;2009.
  • Van den Berg, P.C., J.R. Jansen, and M.R. Pinsky, Effect of positive pressure on venous return in volume-loaded cardiac surgical patients. J Appl Physiol 92. 2002: 1223–1231
  • Saks V., Dzeja P., Schlattner U., Vandelin M., Terzic A., Wallimann T. Cardiac system bioenergetics: Metabolic basis of the Frank-Starling law. J Physiol. 2006; 571 (Pt 2) : 253–273
  • Pellerito Polak , introduction to vasculer ultrasonography ,6 th edition 2012.
  • Lorenzo R.A., Morris M.J., Williams J.B., Haley T.F., Straight T.M., Holbrook V.L.; et al. Does a sımple bedsıde sonographıc measurement of the inferior vena cava correlate to central venous pressure?. The Journal of Emergency Medicine.2012; 42(4): 429–436, 2012.
  • Acosta J.H. Hypertension in cronic renal disease. Kidney Int: 1982;22: 702.
  • Cantin M, Thibault G, Haile-Mesken H. Atrial natriuretic factor in the impuls conduction system of the heart. Trans. Assoc. Am physicions.1988;100-103.
  • Morishita Y, Ando Y, Ishii E, Arisaka M, Kusano E.. Comparison of markers of circulating blood volume in hemodialysis patients. Clin Exp Nephrol. 2005; 9:233–237
  • Akıllı B., Bayır A., Kara F., Ak A., Cander B.. Inferior vena cava diameter as a marker of early hemorrhagic shock: a comparative study. Ulus Travma Acil Cerrahi Derg. 2010; 16(2): 113-118.
  • Shalaby M.I.M., Roshdy H.M., Elmahdy W.M., Mezayen A.E.F.. Correlation between Central Venous Pressure and the Diameter of Inferior Vena Cava by using Ultrasonography for the Assessment of the Volume Status in Intensive Care Unit Patients. The Egyptian Journal of Hospital Medicine . 2018 ;72 (10): 5375-5384
  • Vaish H., Kumar V., Anand R., Chhapola V., Kanwal S.K. The Correlation Between Inferior Vena Cava Diameter Measured by Ultrasonography and Central Venous Pressure. Indian J Pediatr. 2017;84(10):757-762
  • Fayed AM, Abd El Hady WS, El Aleem Abd El Hady MA, El Amir Melika M. Stroke volume variation compared with inferior vena cava distensibility for prediction of fluid responsiveness in mechanically ventilated patients with septic shock. Research and Opinion in Anesthesia & Intensive Care 2020; 7:84–90
  • Donahue S.P., Wood J.P., Patel B.M.,Quinn J.V.. Correlation of sonographic measurement of the internal juguler vein with central venous pressure. American Journal of Medicine. 2009; 27: 851-855.
  • Aydın F, Uzun Y, Mocan M.Z, H. Mocan, Topkara K. Hemodiyaliz Hastalarında Vena Cava İnferior Çapının Klinik Önemi. Omü Tıp Dergisi. 1992; 9(1): 16-19
  • Shefold J.C., Storm C., Bercker S., Pschowski R., Oppert M., Krüger A.; et al. Inferior vena cava diameter correlates with invasive hemodinamic measures in mechanıcally ventilated intensive care patıent with sepsis. The Jour. Of Emergn. Med. 2010; 38(5): 632-637
  • Pacheco S.S., Machado M.N., Amorim R.C., Rol J.L., Correa C.L., Takakura I.T.; et al. Central venous pressure in femoral catheter;correlation with superior approach after heart surgery. Rev Bras Cir Cardiovasc 2008; 23(4): 488-493
  • Boone B.A., Kirk K.A., Tucker N., Gunn S., Forsythe R.. İliac Venous Pressure Estimates Central Venous Pressure After Laporotomy. J.Surg Res. 2014; 191(1):203-207.

Year 2020, Volume: 10 Issue: 4, 474 - 480, 30.12.2020

Meltem İnce Metin Ocak

https://doi.org/10.16899/jcm.728902

Abstract

Giriş: Acil servis ve yoğun bakımdaki hastaların; tanı, tedavi ve takibinde intravasküler volüm durumunun, doğru ve hızlı şekilde tespiti oldukça önemli ve bir o kadar da zordur. Hemodinamik izlemin amacı kardiyovasküler yetmezliği belirlemek ve stabil olmayan kritik düzeydeki hastalara (septik şok, hipovolemi, kardiyojenik şok v.b.) en uygun tedaviyi sağlamaktır.
Amaç: Bu çalışmada amacımız; acil servis ve yoğun bakım ünitesinde, intravasküler volüm durumunu değerlendirmede ve doğru volüm replasmanına yönlenmede ultrasonografi ile vena cava inferior çapı ,vena cava inferior - kollapsibilite indeksi (spontan solunumu olan hastalar için) ve vena cava inferior distensibilite indeksi (mekanik ventilasyon desteğinde soluyan hastalar için) ölçümünün invaziv kateter yerleştirilerek yapılan santral venöz basınç değeri ile karşılaştırılması ve arasındaki ilişkinin saptanmasıdır.
Gereç ve Yöntem: Bu çalışma acil tıp kliniğine 01.06.2014-01.04.2015 tarihleri arasında başvuran veya bu tarihler arasında acil yoğun bakım ünitesinde yatmakta olan, herhangi bir endikasyon ile santral venöz kateter takılan 18 yaş üstü hastalar üzerinde prospektif olarak yürütüldü. Vena cava inferiordan ultrasonografik M mod kullanılarak, hem inspiryum hem de ekspiryum fazında ölçümler alındı ve milimetre cinsinden kaydedildi. Hastalardan eş zamanlı santral venöz basınç ölçümü monometrik cihazlar ile yapıldı ve sonuçlar cm H2O cinsinden kayıt altına alındı.
Bulgular: Hastaların % 43.3’ü kadın (n:26), % 56.7’si erkek (n:34) olup, yaş ortalamaları 70.58 ± 14.86 yıl idi. Santral venöz basınç ile vena cava inferior çapları arasında pozitif yönde, vena cava inferior- kollapsibilite indeksi arasında negatif yönde yüksek derecede korelasyon tespit edildi. Çalışmamızda ayrıca mekanik ventilatör ile solunumu sağlanan hastalarda da vena cava inferior- distensibilite indeksi ve santral venöz basınç arasında negatif yönde yüksek derecede korelasyon olduğu saptandı.
Sonuç: Acil servis ve yoğun bakım ünitelerinde mekanik ventile ya da spontan solunuma sahip olan kritik hastalarda; hızlı, güvenilir, kolay uygulanabilir, maliyeti düşük ve noninvaziv bir yöntem olan ultrasonografi ile vena cava inferior çapındaki respiratuar değişkenlik ölçümü; volüm durumunu değerlendirmede ve santral venöz basıncı tahmin etmede kullanılabilir.

Keywords

Santral Venöz Basınç Vena Cava Inferior Ultrasonografi Volüm Durumu

References

  • Zang Z, Xu X, S Ye, L Xu. Ultrasonographic measurement of the respiratory variation in the inferior vena cava diameter is predictive of volume responsiveness in critically ill patients: systematic review and meta-analysis. Ultrasaound Med. Biol. 2014;40(5):845-556
  • Rivers, E., Nguyen B., Havstad S.,Ressler J, Muzzın A, Knoblich B.; et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19): 368-77.
  • Duane, P.G. and G.L. Colice, Impact of noninvasive studies to distinguish volume overload from ARDS in acutely ill patients with pulmonary edema: analysis of the medical literature from 1966 to 1998. Chest. 2000;118(6): 1709-17
  • Mateer J., Plummer D., Heller M., Olson D., Jehle D., Overton D; et al. Model curriculum for physician training in emergency ultrasonography. Ann Emer Med. 1994; 23:95-102.
  • Plummer D. Whose turf is it, anyway? Diagnostic ultrasonography in the emergency department. Acad Emerg Med. 2007;7:186-187.
  • Mayron R, Gaudio FE, Plummer D, Asinger R, Elsperger J. Echocardiography performed by emergency physicians: Impact on diagnosis and therapy. Ann Emerg Med. 1988; 17: 150–154.
  • Kendall JL, Hoffenberg SR, Smith S. History of emergency and critical care ultrasound: The evolution of a new image paradigm. Crit Care Med. 2007; 35: 126-130
  • Prof. Dr. Şefik Güney ; Kolaylaştırılmış acil ultrason,Maltepe Üniversitesi Radyoloji A.B.D . 2010, 1. Edition
  • Kicher BJ, Himelman RB, Schiller NB. Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol. 1990; 66: 493–496.
  • Barbier C, LoubieresY, Schmit C, Hayon J, Ricome J-L, Jardin F,et all. Respiratory changes in inferior vena cava diamater are helpful in predicting fluid responsiveness in ventilated septic patients. İntensive Care Med 2004;30(9):1740-6
  • Wiedemann HP, Wheeler AP., Bernard G.R., Thompson B.T.,Hayden D., deBoisblanc B.et al National Heart, Lung, and Blood Institute Acute Respiratory Distress Synndrome(ARDS) Clincal Trials Network, Comparison of two volume-management strategies in acute lung injury. N Engl J Med.2006 ;354(24):2564-2575.
  • Levitov A.Mayo PH, Slonim AD. Critical Care Ultrasonography.1 st ed.New York , NY : McGraw-Hill Medical ;2009.
  • Van den Berg, P.C., J.R. Jansen, and M.R. Pinsky, Effect of positive pressure on venous return in volume-loaded cardiac surgical patients. J Appl Physiol 92. 2002: 1223–1231
  • Saks V., Dzeja P., Schlattner U., Vandelin M., Terzic A., Wallimann T. Cardiac system bioenergetics: Metabolic basis of the Frank-Starling law. J Physiol. 2006; 571 (Pt 2) : 253–273
  • Pellerito Polak , introduction to vasculer ultrasonography ,6 th edition 2012.
  • Lorenzo R.A., Morris M.J., Williams J.B., Haley T.F., Straight T.M., Holbrook V.L.; et al. Does a sımple bedsıde sonographıc measurement of the inferior vena cava correlate to central venous pressure?. The Journal of Emergency Medicine.2012; 42(4): 429–436, 2012.
  • Acosta J.H. Hypertension in cronic renal disease. Kidney Int: 1982;22: 702.
  • Cantin M, Thibault G, Haile-Mesken H. Atrial natriuretic factor in the impuls conduction system of the heart. Trans. Assoc. Am physicions.1988;100-103.
  • Morishita Y, Ando Y, Ishii E, Arisaka M, Kusano E.. Comparison of markers of circulating blood volume in hemodialysis patients. Clin Exp Nephrol. 2005; 9:233–237
  • Akıllı B., Bayır A., Kara F., Ak A., Cander B.. Inferior vena cava diameter as a marker of early hemorrhagic shock: a comparative study. Ulus Travma Acil Cerrahi Derg. 2010; 16(2): 113-118.
  • Shalaby M.I.M., Roshdy H.M., Elmahdy W.M., Mezayen A.E.F.. Correlation between Central Venous Pressure and the Diameter of Inferior Vena Cava by using Ultrasonography for the Assessment of the Volume Status in Intensive Care Unit Patients. The Egyptian Journal of Hospital Medicine . 2018 ;72 (10): 5375-5384
  • Vaish H., Kumar V., Anand R., Chhapola V., Kanwal S.K. The Correlation Between Inferior Vena Cava Diameter Measured by Ultrasonography and Central Venous Pressure. Indian J Pediatr. 2017;84(10):757-762
  • Fayed AM, Abd El Hady WS, El Aleem Abd El Hady MA, El Amir Melika M. Stroke volume variation compared with inferior vena cava distensibility for prediction of fluid responsiveness in mechanically ventilated patients with septic shock. Research and Opinion in Anesthesia & Intensive Care 2020; 7:84–90
  • Donahue S.P., Wood J.P., Patel B.M.,Quinn J.V.. Correlation of sonographic measurement of the internal juguler vein with central venous pressure. American Journal of Medicine. 2009; 27: 851-855.
  • Aydın F, Uzun Y, Mocan M.Z, H. Mocan, Topkara K. Hemodiyaliz Hastalarında Vena Cava İnferior Çapının Klinik Önemi. Omü Tıp Dergisi. 1992; 9(1): 16-19
  • Shefold J.C., Storm C., Bercker S., Pschowski R., Oppert M., Krüger A.; et al. Inferior vena cava diameter correlates with invasive hemodinamic measures in mechanıcally ventilated intensive care patıent with sepsis. The Jour. Of Emergn. Med. 2010; 38(5): 632-637
  • Pacheco S.S., Machado M.N., Amorim R.C., Rol J.L., Correa C.L., Takakura I.T.; et al. Central venous pressure in femoral catheter;correlation with superior approach after heart surgery. Rev Bras Cir Cardiovasc 2008; 23(4): 488-493
  • Boone B.A., Kirk K.A., Tucker N., Gunn S., Forsythe R.. İliac Venous Pressure Estimates Central Venous Pressure After Laporotomy. J.Surg Res. 2014; 191(1):203-207.
There are 28 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Research
Authors

Meltem İnce This is me 0000-0003-2530-509X

Metin Ocak 0000-0002-9978-0216

Publication Date December 30, 2020
Acceptance Date August 26, 2020
Published in Issue Year 2020 Volume: 10 Issue: 4

Cite

AMA İnce M, Ocak M. The Most Useful Method To Evaluate The Volume Status Of Critical Patients In The Emergency And Intensive Care Units: Point Of Care Ultrasound. J Contemp Med. December 2020;10(4):474-480. doi:10.16899/jcm.728902
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