Qing Zhang1, Xiaoting Wang1, Longxiang Su1, Hongmin Zhang1, Wenzhao Chai1, Yangong Chao2, Wei He3, Dawei Liu1. 1. Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China. 2. Department of Critical Care Medicine, Hua Xin Hospital, Tsinghua University, Beijing, China. 3. Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Abstract
PURPOSE: To explore the relationship between the shape of the inferior vena cava (IVC) lumen and central venous pressure (CVP). METHODS: In 60 patients undergoing mechanical ventilation and CVP monitoring in the Intensive Care Unit of Peking Union Medical College Hospital from July to October 2016, we measured with B-mode ultrasonography the transverse maximum (MXD) and minimum diameter (MID) of the IVC at end expiration, and calculated the diameter ratio (DR) as MXD/MID. Patients were divided into three groups according to CVP: low (CVP < 8 mm Hg), intermediate (8 mm Hg ≤ CVP ≤ 10 mm Hg), and high (CVP > 10 mm Hg). RESULTS: MXD was 2.32 ± 0.41 cm, MID was 1.41 ± 0.40 cm, and DR was 1.76 ± 0.49. CVP was 9.27 ± 2.99 mm Hg. DR correlated with CVP (r = -0.527, P < .001). The low-CVP group had greater dispersion of DR values, with a large variety in IVC shape (elliptical, irregular, teardrop-shaped, partially collapsed…). The area under the ROC curve for predicting CVP with DR, with a CVP threshold of 8 mm Hg was 0.835 (95% CI, 0.726-0.945; P < .05). With a DR cutoff value of 1.76, sensitivity was 0.765 and specificity was 0.781. CONCLUSIONS: DR above 1.7 is predictive of CVP < 8 mm Hg.
PURPOSE: To explore the relationship between the shape of the inferior vena cava (IVC) lumen and central venous pressure (CVP). METHODS: In 60 patients undergoing mechanical ventilation and CVP monitoring in the Intensive Care Unit of Peking Union Medical College Hospital from July to October 2016, we measured with B-mode ultrasonography the transverse maximum (MXD) and minimum diameter (MID) of the IVC at end expiration, and calculated the diameter ratio (DR) as MXD/MID. Patients were divided into three groups according to CVP: low (CVP < 8 mm Hg), intermediate (8 mm Hg ≤ CVP ≤ 10 mm Hg), and high (CVP > 10 mm Hg). RESULTS: MXD was 2.32 ± 0.41 cm, MID was 1.41 ± 0.40 cm, and DR was 1.76 ± 0.49. CVP was 9.27 ± 2.99 mm Hg. DR correlated with CVP (r = -0.527, P < .001). The low-CVP group had greater dispersion of DR values, with a large variety in IVC shape (elliptical, irregular, teardrop-shaped, partially collapsed…). The area under the ROC curve for predicting CVP with DR, with a CVP threshold of 8 mm Hg was 0.835 (95% CI, 0.726-0.945; P < .05). With a DR cutoff value of 1.76, sensitivity was 0.765 and specificity was 0.781. CONCLUSIONS: DR above 1.7 is predictive of CVP < 8 mm Hg.
Authors: Sebastian Voicu; Chahinez Ketfi; Alain Stépanian; Benjamin G Chousterman; Nassim Mohamedi; Virginie Siguret; Alexandre Mebazaa; Bruno Mégarbane; Philippe Bonnin Journal: Front Physiol Date: 2021-01-08 Impact factor: 4.566