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

Öz

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.

Anahtar Kelimeler

• Central Venous Pressure
• Vena Cava Inferior
• Ultrasonography
• Volume Status

Öz

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.

Anahtar Kelimeler

• Santral Venöz Basınç
• Vena Cava Inferior
• Ultrasonografi
• Volüm Durumu

Kaynakça

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