Sonographic inferior vena cava/aorta diameter index, a new approach to the body fluid status assessment in children and young adults in emergency ultrasound—preliminary study

doi:10.1016/j.ajem.2007.07.012

The American Journal of Emergency Medicine

Volume 26, Issue 3, March 2008, Pages 320-325

https://doi.org/10.1016/j.ajem.2007.07.012 Get rights and content

Abstract

Body fluid status is one of the most important parameters estimated during every clinical examination. In many disorders, the therapy and its effectiveness depend on appropriate evaluation of body water status. There are some useful methods of evaluating body fluid incontinence; however, all of them are burdened with some limitations, especially when used in the emergency department.

We introduce a new sonographic parameter, the “inferior vena cava (IVC)/aorta (Ao) diameter (IVC/Ao) index,” as a convenient, quick, and effective way of evaluating body fluid status. The usefulness of the sonographic assessment of IVC diameter has already been proven in children with nephrotic syndrome, in hemodialysis patients, and in patients hospitalized in intensive care units. However, this method is limited by the necessity of comparing IVC diameter to body surface, measuring IVC diameter during maximal inspiration and expiration, or lack of reference values for the pediatric population, which can be eliminated in our new method of body fluid status assessment.

Introduction

An accurate assessment of the body fluid status is a significant challenge during every clinical examination. In many disorders, the therapy and its effectiveness depend on appropriate evaluation of body water status, especially in patients hospitalized in the emergency, nephrology, and pediatric departments.

There are many useful methods of evaluating percentage of water incontinence in body tissues, such as clinical examination, biochemical markers, bioimpedance, continuous blood volume measurement, or sonographic inferior vena cava (IVC) diameter assessment. However, all of these methods are burdened with some limitations when used in clinical practice.

The advantages of ultrasound imaging are commonly known and ultrasound units are present in every emergency department (ED) where fast imaging technique is indispensable. Therefore, in this article we concentrated on the last mentioned method of body fluid status assessment. The usefulness of the sonographic assessment of IVC diameter has been proven in patients with impaired kidney function treated with hemodialysis, patients with nephritic syndrome, or patients hospitalized in intensive care wards. Simultaneously, we are aware of some limitations of this method, such as problems with equipment, necessity of comparing results with body surface area (BSA), measurement of IVC diameter during maximal inspiration and expiration (needing cooperation of the patient), and lack of reference values for IVC diameter especially in the pediatric population. For these reasons, we introduce a new sonographic parameter, the “IVC/aorta (Ao) diameter (IVC/Ao) index,” an innovation that is convenient, fast, easy to perform, and effective in the evaluation of body fluid status, especially in EDs.

Section snippets

Part 1

Fifty-two healthy volunteers (students of medicine; 29 women, 23 men), aged between 20 and 25 years, were enrolled into the study. One woman was excluded because of elevated blood pressure values. In the ultrasound examination, we concentrated on assessment of IVC and aorta diameters. The measurements were performed twice, initially at 8 am after 12 hours of fasting (“physiological dehydration” status) and 6 to 8 hours later after intake of 1500 to 2000 mL of fluids or around 70% to 90% of the

Examination technique

The ultrasound examination was taken with the subject in a supine position with the transducer placed underneath the xiphoid process in a longitudinal direction. The IVC diameter was measured beneath the confluence with hepatic veins, where its anterior and posterior wall were parallel (Fig. 1). The IVC diameter was measured during a regular breathing cycle, and the maximum value was recorded. The aorta diameter was taken in a similar way, 5 to 10 mm above the celiac trunk.

Part 1

The measurements were performed in all volunteers. There was a statistically significant increase in body weight before and after fluid intake: 0.74 kg ± 0.65 (P < .00001).

The IVC and aorta diameters significantly increased after fluid intake (P < .05). However, there was no statistically significant difference in aorta diameter if calculated per square meter of BSA (P = .08). When IVC diameter value was calculated in the same way the difference was statistically significant (P = .00004) (Table

Discussion

The accuracy of body fluid status assessment plays a significant role in the diagnostic and therapeutic processes of acute and chronic disorders, influencing their further treatment and final recovery. There are different methods of evaluating body hydration status, but none of them is optimal and all of them have some limitations [1].

From a practical point of view the ideal method should be easy to perform, quick, precise, and repetitive. There are many optimistic reports pointing to the

Conclusions

1.
For the healthy population aged 20 to 30 years, we suggest the IVC/Ao index reference value of 1.2 ± 2 SD for SD = 0.17.
2.
IVC/Ao index seems to be a very useful parameter for estimating body fluid status and there is necessity of further evaluation of its value in clinical practice especially in the pediatric population.

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The pediatric ultrasound measurement of the inferior vena cava (IVC) and aorta (AO) with the study of the collapsibility index (CI) and of IVC-to-AO ratio (IVC/AO) can provide clinicians in the acute care setting with information on abnormal volume status but one of the major limitations is a lack of reference normal values by body surface area (BSA) and age. The aim of this study was to provide reference ranges for the sonographic measurement of IVC, AO, and IVC/AO ratio in healthy Caucasian Italian children.
We enrolled prospectively 516 healthy Caucasian Italian children aged between 1 month and 16 years. Echocardiographic IVC and AO diameters were collected and presented separately for children aged ≤1 year and for children aged over 1 year. For children >1 year we categorized subjects into 3 years classes. CI and IVC/AO for the systolic aortic diameter were then calculated. For children over 1 year, age reference ranges were age-related or BSA-related; for children of ≤1 year, reference ranges were determined with their 90% confidence intervals regardless of age and of BSA.
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CI was 30% (SD 17%) in children >1 year and 36% (SD 16%) in children <1 year. IVC/AOs showed age-dependent values from 0.83 (SD 0.20) age <1 year to 1.22 (SD 0.31) in older subjects.
We report reliable reference ranges for echocardiographic measurement of IVC, AO, CI, and IVC/AO for a Caucasian Italian healthy pediatric population.
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The aim of this study was to evaluate the utility of ultrasonographic measurement of the diameter of the inferior vena cava (IVCD) and abdominal aorta (AAD) for assessing volume status.
This was a prospective, observational study. A total of 23 volunteers participated in the study. Each participant was selected randomly. All participants completed the 2016 Kaunas Marathon. Participants filed out a brief survey about their fluid intake (in standardised glasses) in the 24 h before the race and during the race. Participants underwent ultrasound measurements 10–40 min before the start of the race and 3–15 min after finishing the race. To visualize respiratory variation, M-mode was used, with the beam crossing the IVCD 2 cm from the right atrium. The AAD was measured 1 cm above the celiac trunk. IVCD in expiration (IVCDexp)/AAD was calculated by dividing the value of IVCDexp by the value of AAD. The findings were compared with difference in body mass index.
The mean weight lost after the marathon was 2.93 kg (p < 0.001). Mean IVCD in inspiration (IVCDins) after the run was lower by 0.39 cm (p < 0.001) then before the run. Mean IVCDexp/AAD after the run was 0.24 cm lower than before the run (p = 0.03). Before and after the marathon, there was a statistically significant negative correlation in weight difference, with mean IVCDexp difference (p = 0.047). There was no statistically significant difference in caval index before and after running.
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Se realizó una revisión de la literatura no sistemática en las bases de datos PubMed, Medline, Lilacs, Science Direct y Springer, de los trabajos publicados desde 1 de enero de 1980 hasta el 31 de julio del 2017.
En ciertas circunstancias, el índice de vena cava inferior puede considerarse como una herramienta que permita estimar el estado volumétrico del paciente para la toma de decisiones clínicas en los pacientes en estado crítico.
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The inferior vena cava index (IVC) is a measurement that can provide an estimation of the intravascular volume using ultrasound to measure collapsibility of the inferior vein cava, which under physiological conditions is associated with respiratory movements.
To review the usefulness of IVC as a tool to estimate the volumetric status in patients in the Emergency Department and Intensive Care.
A non-systematic review of the literature published from January 1, 1980 to July 31, 2017 was performed using PubMed, Medline Medline, Lilacs, Science Direct and Springer data bases.
Under certain circumstances, the inferior vena cava index can be considered as a tool to estimate the volumetric status of the patienfor clinical decision-making in critically ill patients.
It is an easy-to-use tool that still needs clinical evidence, although it can still help in decision making in Emergency Department and Intensive Care treatment.
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Inferior vena cava to aorta ratio in dehydrated pediatric patients: a systematic review and meta-analysis
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Brief ReportSonographic inferior vena cava/aorta diameter index, a new approach to the body fluid status assessment in children and young adults in emergency ultrasound—preliminary study

Abstract

Introduction

Section snippets

Part 1

Examination technique

Part 1

Discussion

Conclusions

Methods of assessment of volume status and intercompartmental fluid shifts in hemodialysis patients: implications in clinical practice

Semin Dial

Changes of the cardiac architectures and functions for chronic hemodialysis patients with dry weight determined by echocardiography

Blood Purif

The adjustment of post-dialysis dry weight based on non-invasive measurements in children

Nephrol Dial Transplant

Inferior vena cava diameter: a useful method for estimation of fluid status in children on haemodialysis

Nephrol Dial Transplant

Inferior vena cava indices determine volume load in minimal lesion nephrotic syndrome

Pediatr Nephrol

Early diagnosis of hypovolemic shock by sonographic measurement of inferior vena cava in trauma patients

J Trauma

Brief Report
Sonographic inferior vena cava/aorta diameter index, a new approach to the body fluid status assessment in children and young adults in emergency ultrasound—preliminary study