Correlation Between Central Venous Pressure Measurement and Inferior Vena Cava and Aortic Diameter Assessment Using Bedside Ultrasonography in the Emergency Department

Abstract

Objective: The aim of this study is to investigate the correlation between inferior vena cava diameter measurement using bedside ultrasound and invasive central venous pressure (CVP) measurement as an alternative to invasive methods for managing fluid therapy in patients diagnosed with hypovolemic shock. Material and Methods: A total of 100 adult patients admitted to the Emergency Department of Uludağ University between September 2015 and January 2016 were included in the study. Patients were divided into three groups based on CVP values: <8 cmH2O (low), 8–12 cmH2O (normal), and >12 cmH2O (high). Hemodynamic data (pulse, blood pressure) and ultrasonographic measurements (IVC diameter during inspiration and expiration, IVC/Ao ratio, collapsibility index) of each group were statistically analyzed. Results: Patients with CVP <8 cmH2O had significantly lower systolic and diastolic blood pressures (p<0.05) and higher pulse rates compared to other groups. Inspiratory anteroposterior and mediolateral IVC diameters, as well as the IVC/Ao ratio, were significantly lower in this group (p<0.05). The collapsibility index was significantly higher (>50%) in patients with low CVP (p=0.002). No significant differences were observed in expiratory diameters among the groups. Conclusion: Bedside ultrasonographic parameters, particularly IVC diameters, collapsibility index, and IVC/Ao ratio, are strongly correlated with invasive CVP values and can serve as reliable, rapid, and non-invasive indicators of intravascular volume status in hypovolemic patients. These findings highlight the potential clinical applicability of bedside ultrasound in guiding fluid management in the emergency department.

Keywords

• Central Venous Pressure
• Inferior vena cava
• Bedside ultrasonography
• Hypovolemic shock

Acil Serviste Yatakbaşı Ultrasonografi ile Vena Kava İnferior ve Aort Çapı Ölçümü ile Santral Venöz Basınç Ölçümünün İlişkilendirilmesi

Abstract

Amaç: Bu çalışmanın amacı, hipovolemik şok tanısı alan hastalarda sıvı tedavisini yönetmek için invaziv yöntemlere alternatif olarak yatak başında yapılan ultrason ile inferior vena kava çapı ölçümü ile invaziv santral venöz basınç (CVP) ölçümü arasındaki korelasyonu araştırmaktır. Gereç ve Yöntem: Eylül 2015 ile Ocak 2016 tarihleri arasında Uludağ Üniversitesi Acil Servisi’ne başvuran toplam 100 yetişkin hasta çalışmaya dahil edildi. Hastalar CVP değerlerine göre üç gruba ayrıldı: <8 cmH2O (düşük), 8–12 cmH2O (normal) ve >12 cmH2O (yüksek). Her grubun hemodinamik verileri (nabız, kan basıncı vs.) ve ultrasonografik ölçümleri (inspirasyon ve ekspirasyon sırasında IVC çapı, IVC/Ao oranı, kollapsibilite indeksi) istatistiksel olarak analiz edildi. Bulgular: CVP <8 cmH2O olan hastalar, diğer gruplara kıyasla sistolik ve diyastolik kan basınçları anlamlı olarak daha düşük (p<0,05) ve nabız hızları daha yüksekti. Bu grupta inspiratuar anteroposterior ve mediolateral IVC çapları ile IVC/Ao oranı anlamlı olarak daha düşüktü (p<0,05). Kollapsibilite indeksi, düşük CVP’li hastalarda anlamlı olarak daha yüksekti (>%50) (p=0,002). Gruplar arasında ekspiratuar çaplarda anlamlı fark gözlenmedi. Sonuç: Yatak başı ultrasonografik parametreler, özellikle IVC çapları, kollaps indeksi ve IVC/Ao oranı, invaziv CVP değerleri ile güçlü bir korelasyon göstermektedir ve hipovolemik hastalarda intravasküler hacim durumunun güvenilir, hızlı ve noninvaziv göstergeleri olarak kullanılabilir. Bu bulgular, acil serviste sıvı yönetiminin yönlendirilmesinde yatak başı ultrasonun potansiyel klinik uygulanabilirliğini vurgulamaktadır.

Keywords

• santral venöz basınç
• hipovolemik şok
• yatakbaşı ultrasonografi
• vena kava inferior

References

1. Orenstein WA, Hinman A, Nkowane B, Olive JM, Reingold A. Measles and rubella global strategic plan 2012–2020 midterm review. Vaccine. 2018;36 Suppl 1:A1–A34. doi:10.1016/j.vaccine.2017.09.026
2. Cetinkaya RA, Yenilmez E. The seroprevalence of rubella in pregnant women in Turkey: a meta-analysis research of 90988 Rubella IgM, 84398 Rubella IgG, and 522 avidity results. Turk J Obstet Gynecol. 2019;16(1):63–71. doi:10.4274/tjod.galenos.2018.89663
3. Mongua-Rodriguez N, Díaz-Ortega JL, García-García L, Ferreira-Guerrero E, García-Sancho C, Gutiérrez G, et al. A systematic review of rubella vaccination strategies implemented in the Americas: impact on incidence and seroprevalence rates of rubella and congenital rubella syndrome. Vaccine. 2013;31(17):2145–51. doi:10.1016/j.vaccine.2013.02.047
4. Nasika A, Bogogiannidou Z, Mouchtouri VA, Kourlaba G, Sfikakis PP, Panagiotakopoulos G, et al. Measles immunity status of Greek population after the outbreak in 2017–2018: results from a seroprevalence national survey. Vaccines (Basel). 2023;11(7):1220. doi:10.3390/vaccines11071220
5. Barah F, Chehada AG. Prevalence of rubella IgG antibodies among Syrian females of childbearing age. Saudi Med J. 2010;31(1):78–81. PMID: 20029196.
6. Meng Q, Luo J, Li L, Li Y, Bao C, Wang X, et al. Rubella seroprevalence among pregnant women in Beijing, China. BMC Infect Dis. 2018;18(1):130. doi:10.1186/s12879-018-3032-x
7. Thayyil J, Kuniyil V, Moorkoth AP, Rao B, Selvam P. Prevalence of rubella-specific IgG antibodies in unimmunized young female population. J Family Med Prim Care. 2016;5(3):658–62. doi:10.4103/2249-4863.197311
8. Mahjour J. WHO warns of increased risk of disease epidemics in Syria and in neighbouring countries as summer approaches. Cairo: World Health Organization Regional Office for the Eastern Mediterranean; 2013. Available from: https://www.emro.who.int/ (Accessed: 1 June 2025).

9. Yucel Celik O, Aksu G, Obut M, Keleş A, Gültekin Çalık M, Dağdeviren G, et al. Rubella immunity in native Turkish and Syrian immigrant pregnant women between 2010–2018. Eur Res J. 2022;8(1):37–43. doi:10.18621/eurj.827322
10. Kul G, Turan G. Comparison of Toxoplasma and rubella seropositivity rates of Syrian and Turkish pregnant women. Cukurova Med J. 2021;46(3):975–81. DOI: 10.17826/cumj.903637
11. Nalça-Erdin B, Ekenoğlu-Merdan Y, Can B, Öztürk R, Gültekin H, Karadağ A, et al. Evaluation of Toxoplasma gondii, rubella, and CMV antibody positivity and avidity test results in female patients admitted to a state hospital in İstanbul. Klimik Derg. 2024;37(2):110–4. doi:10.5152/kd.2024.23136
12. Özmert EN. Dünya’da ve Türkiye’de aşılama takvimindeki gelişmeler. Cocuk Sagligi Hast Derg. 2008;51(3):168–75. Available from: https://cshd.org.tr/article/view/383 (Accessed: 1 June 2025).
13. Zahradeen SU, Muhammad ID, Adamou N, Rabiu A, Yusuf MA, Shuaibu SAD, Ibrahim G. Seroprevalence and risk factors for rubella infection in pregnant women attending a tertiary hospital in Kano-Nigeria. Pan Afr Med J. 2023 Dec 4;46:97. doi: 10.11604/pamj.2023.46.97.39433. PMID: 38405097; PMCID: PMC10891375.
14. Eiset AH, Wejse C. Review of infectious diseases in refugees and asylum seekers: current status and going forward. Public Health Rev. 2017;38:22. doi:10.1186/s40985-017-0065-4
15. Mipatrini D, Stefanelli P, Severoni S, Rezza G. Vaccinations in migrants and refugees: a challenge for European health systems. A systematic review of current scientific evidence. Pathog Glob Health. 2017;111(2):59–68. doi:10.1080/20477724.2017.1281374