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      IJV collapsibility index vs IVC collapsibility index by point of care ultrasound for estimation of CVP: a comparative study with direct estimation of CVP

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          Abstract

          Purpose

          To compare the bedside ultrasound estimation of internal jugular vein (IJV)-collapsibility index with inferior vena cava (IVC)-collapsibility index and invasively monitored central venous pressure (CVP) in ICU patients.

          Design

          prospective observational study.

          Setting

          The study was carried out in the ICU of Al Wakra and Al Khor hospitals of the Hamad Medical Corporation, Qatar. The patients were enrolled from November 2013 to January 2015.

          Patients

          Patients admitted to the ICU with central venous catheter were included.

          Material and methods

          The A-P diameter, cross-sectional area of the right IJV, and diameter of IVC were measured using bedside USG, and their corresponding collapsibility indices were obtained. The results of the IJV and IVC indices were compared with CVP. The sensitivity, specificity, and positive and negative predictive values were calculated to determine the diagnostic and predictive accuracy of the IJV collapsibility index in predicting the CVP.

          Results

          Seventy patients were enrolled, out of which 12 were excluded. The mean age was 54.34±16.61 years. The mean CVP was 9.88 mmHg (range =1–25) . The correlations between CVP and IJV-CI (collapsibility index) at 0° were r =−0.484 ( P=0.0001), r=−0.416 ( P=0.001) for the cross-sectional area (CSA) and the diameter, respectively, and, at 30°, the most significant correlation discovered was ( r=−0.583, P=0.0001) for the CSA-CI and r =−0.559 ( P=0.0001) for the diameter-CI. In addition, there was a significant and negative correlation between IVC-CI and CVP (r=−0.540, P=0.0001).

          Conclusion

          The IJV collapsibility index, especially at 30° head end elevation, can be used as a first-line approach for the bedside non-invasive assessment of CVP/fluid status in critical patients. IVC-CI can be used either as an adjunct or in conditions where IJV assessment is not possible, such as in the case of a neck trauma/surgery.

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          Most cited references43

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          Point-of-care ultrasonography.

          Christopher L. Moore, Joshua A. Copel (2011)
          Article 0 comments Cited 408 times – based on 0 reviews     Review now
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            Septic shock.

            Djillali Annane, Eric Bellissant, Jean-Marc Cavaillon (2005)
            Septic shock, the most severe complication of sepsis, is a deadly disease. In recent years, exciting advances have been made in the understanding of its pathophysiology and treatment. Pathogens, via their microbial-associated molecular patterns, trigger sequential intracellular events in immune cells, epithelium, endothelium, and the neuroendocrine system. Proinflammatory mediators that contribute to eradication of invading microorganisms are produced, and anti-inflammatory mediators control this response. The inflammatory response leads to damage to host tissue, and the anti-inflammatory response causes leucocyte reprogramming and changes in immune status. The time-window for interventions is short, and treatment must promptly control the source of infection and restore haemodynamic homoeostasis. Further research is needed to establish which fluids and vasopressors are best. Some patients with septic shock might benefit from drugs such as corticosteroids or activated protein C. Other therapeutic strategies are under investigation, including those that target late proinflammatory mediators, endothelium, or the neuroendocrine system.
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              Epidemiology of trauma deaths: a reassessment.

              A Sauaia, F Moore, E. E. Moore … (1995)
              Recognizing the impact of the 1977 San Francisco study of trauma deaths in trauma care, our purpose was to reassess those findings in a contemporary trauma system. Cross-sectional. All trauma deaths occurring in Denver City and County during 1992 were reviewed; data were obtained by cross-referencing four databases: paramedic trip reports, trauma registries, coroner autopsy reports and police reports. There were 289 postinjury fatalities; mean age was 36.8 +/- 1.2 years and mean Injury Severity Score (ISS) was 35.7 +/- 1.2. Predominant injury mechanisms were gunshot wounds in 121 (42%), motorvehicle accidents in 75 (38%) and falls in 23 (8%) cases. Seven (2%) individuals sustained lethal burns. Ninety eight (34%) deaths occurred in the pre-hospital setting. The remaining 191 (66%) patients were transported to the hospital. Of these, 154 (81%) died in the first 48 hours (acute), 11 (6%) within three to seven days (early) and 26 (14%) after seven days (late). Central nervous system injuries were the most frequent cause of death (42%), followed by exsanguination (39%) and organ failure (7%). While acute and early deaths were mostly due to the first two causes, organ failure was the most common cause of late death (61%). In comparison with the previous report, we observed similar injury mechanisms, demographics and causes of death. However, in our experience, there was an improved access to the medical system, greater proportion of late deaths due to brain injury and lack of the classic trimodal distribution.
              Article 0 comments Cited 227 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Open Access Emerg Med
                Journal ID (iso-abbrev): Open Access Emerg Med
                Journal ID (publisher-id): Open Access Emergency Medicine
                Title: Open Access Emergency Medicine : OAEM
                Publisher: Dove Medical Press
                ISSN (Electronic): 1179-1500
                Publication date Collection: 2019
                Publication date (Electronic): 03 April 2019
                Volume: 11
                Pages: 65-75
                Affiliations
                [1 ]Intensive Care Department, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
                [2 ]Accident & Emergency Department, Al Khor Hospital, Hamad Medical Corporation, Doha, Qatar, nousha87@ 123456hotmail.com
                [3 ]Medical Research Department, Hamad Medical Corporation, Doha, Qatar
                [4 ]Department of Internal Medicine, Al Khor Hospital, Hamad Medical Corporation, Doha, Qatar
                Author notes
                Correspondence: Vamanjore A Naushad, Accident & Emergency Department, Al Khor Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar, Tel +974 55 902 242, Email nousha87@ 123456hotmail.com
                Article
                Publisher ID: oaem-11-065
                DOI: 10.2147/OAEM.S176175
                PMC ID: 6452797
                PubMed ID: 31040727
                SO-VID: f4560781-e3d6-47cc-949c-915b88068fc7
                Copyright © © 2019 Jassim et al. This work is published and licensed by Dove Medical Press Limited
                License:

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Subject: Original Research

                Keywords: internal jugular vein,inferior vena cava,collapsibility index,point of care,ultrasound,central venous pressure,ijv,ivc,ci
                Data availability:
                Keywords: internal jugular vein, inferior vena cava, collapsibility index, point of care, ultrasound, central venous pressure, ijv, ivc, ci

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