Correlating IVC Measurements with Intravascular Volume Changes at Three Distinct Measurement Sites

Abstract

Bedside ultrasound of the inferior vena cava (IVC) has grown to be an important tool in the assessment and management of critically ill patients. This study endeavors to examine which location along the IVC is most highly correlated with changes in intravascular volume status: (1) the diaphragmatic juncture (DJ) (2) two centimeters caudal to the hepatic vein juncture (2HVJ) or (3) left renal vein juncture (LRVJ). Data was collected in this prospective observational study on patients in the emergency department who were at least 16 years of age, being treated with intravenous fluids (IVF). Measurements of the IVC were recorded at each site during standard inspiratory and expiratory cycles, and again with the patient actively sniffing to decrease intrapleural pressures. IVF was then administered per the patient’s predetermined treatment, and the same six measurements were repeated after completion of fluid bolus. The difference in caval index (dCI) was calculated for all six data sets and correlated with the mL/kg of IVF administered. There was a statistically significant correlation between mL/kg of IVFs administered and dCI at all three sites (DJ: r = 0.354, p value = 0.0002; 2HVJ: r = 0.334, p value = 0.0003; LRVJ: r = 0.192, p value = 0.03). The greatest correlation between amount of fluids administered and dCI was observed along the IVC at the site 2 cm caudal to the juncture of the hepatic veins (2HVJ). This site is also where the largest change in diameter can be appreciated on ultrasound during intravascular volume resuscitation. Our data also suggests that every mL/kg of IVFs administered should change the dCI by 0.86-1.00%. This anticipated change in IVC diameter can be used to gauge a patient’s response to intravascular volume repletion.