Citation Information :
Inci K, Gürsel G. Accuracy of Pocket-sized Ultrasound Devices to Evaluate Inferior Vena Cava Diameter and Variability in Critically Ill Patients. Indian J Crit Care Med 2024; 28 (4):369-374.
Purpose: By using inferior vena cava (IVC) measurements, clinicians can detect fluid status and responsiveness and find out the etiology of hypotension, acute heart failure, and sepsis easier. Pocket-sized ultrasound devices (PSUD) may take this advantage a few steps further by their lower costs, user-friendly interface, and easily applicable structure.
In this study, we aimed to determine the diagnostic value of a PSUD compared with a standard ultrasound device (SD) for the measurement of IVC diameter (IVCD) and its respiratory variability.
Materials and methods: We measured the inspiratory, expiratory diameters of IVC, and calculated the inferior vena cava collapsibility index (IVCCI). We investigated 42 intensive care unit (ICU) patients.
Results: There was no difference in inspiratory (PSUD: 1.34 ± 0.67 cm; SD: 1.35 ± 0.68 cm) and expiratory (PSUD: 1.98 ± 0.53 cm; SD: 2.01 ± 0.49 cm) IVCD among measurements with PSUD and SD (p > 0.05). There was also no difference between IVCCI's measured with PSUD (39 ± 20%) and SD (39 ± 20%) (p > 0.05). The Bland–Altman analysis revealed that the width of 95% limits of agreement were similar for both devices. There was a good inter-device agreement among PSUD and SD for measurements of IVCD, and there was no difference between IVCCI's measured using both ultrasound devices.
Conclusion: We support that the idea of a PSUD is as reliable as a SD for IVC measurements.
Price S, Platz E, Cullen L, Tavazzi G, Christ M, Cowie MR, et al. Acute Heart Failure Study Group of the European Society of Cardiology Acute Cardiovascular Care Association. Expert consensus document: Echocardiography and lung ultrasonography for the assessment and management of acute heart failure. Nat Rev Cardiol 2017;14(7): 427–440. DOI: 10.1038/nrcardio.2017.56.
Marik PE. Fluid responsiveness and the six guiding principles of fluid resuscitation. Crit Care Med 2016;44(10):1920–1922. DOI: 10.1097/CCM.0000000000001483.
Javali RH, Loganathan A, Srinivasarangan M, Patil A, Siddappa GB, Satyanarayana N, et al. Reliability of emergency department diagnosis in identifying the etiology of nontraumatic undifferentiated hypotension. Indian J Crit Care Med 2020;24(5):313–320. DOI: 10.5005/jp-journals-10071-23429.
Garg M, Sen J, Goyal S, Chaudhry D. Comparative evaluation of central venous pressure and sonographic inferior vena cava variability in assessing fluid responsiveness in septic shock. Indian J Crit Care Med 2016;20(12):708–713. DOI: 10.4103/0972-5229.195706.
Porter TR, Shillcutt SK, Adams MS, Desjardins G, Glas KE, Olson JJ, et al. Guidelines for the use of echocardiography as a monitor for therapeutic intervention in adults: A report from the American Society of Echocardiography. J Am Soc Echocardiogr 2015;28(1): 40–56. DOI: 10.1016/j.echo.2014.09.009.
Schmidt GA, Koenig S, Mayo PH. Shock: Ultrasound to guide diagnosis and therapy. Chest 2012;142(4):1042–1048. DOI: 10.1378/chest.12-1297.
Abu-Zidan FM. Optimizing the value of measuring inferior vena cava diameter in shocked patients. World J Crit Care Med 2016;5(1):7–11. DOI: 10.5492/wjccm.v5.i1.7.
Seraphim A, Paschou SA, Grapsa J, Nihoyannopoulos P. Pocket-sized echocardiography devices: One stop shop service? J Cardiovasc Ultrasound 2016;24(1):1–6. DOI: 10.4250/jcu.2016.24.1.1.
Esposito R, Ilardi F, Schiano Lomoriello V, Sorrentino R, Sellitto V, Giugliano G, et al. Identification of the main determinants of abdominal aorta size: A screening by pocket size imaging device. Cardiovasc Ultrasound 2017;15(1):2. DOI: 10.1186/s12947-016-0094-z.
Gursel G, Inci K, Alasgarova Z. Can diaphragm dysfunction be reliably evaluated with pocket-sized ultrasound devices in ıntensive care unit? Crit Care Res Pract 2018;2018:5192647. DOI: 10.1155/2018/5192647.
Wallace DJ, Allison M, Stone MB. Inferior vena cava percentage collapse during respiration is affected by the sampling location: An ultrasound study in healthy volunteers. Acad Emerg Med 2010;17(1):96–99. DOI: 10.1111/j.1553-2712.2009.00627.x.
Lu MJ, Zhong WH, Liu YX, Miao HZ, Li YC, Ji MH. Sample size for assessing agreement between two methods of measurement by Bland-Altman method. Int J Biostat 2016;12(2):/j/ijb.2016.12.issue-2/ijb-2015-0039/ijb-2015-0039.xml. DOI: 10.1515/ijb-2015-0039.
Levitov A, Frankel HL, Blaivas M, Kirkpatrick AW, Su E, Evans D, et al. Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients-part II: Cardiac ultrasonography. Crit Care Med 2016;44(6):1206–1227. DOI: 10.1097/CCM.0000000000001847.
Muller L, Bobbia X, Toumi M, Louart G, Molinari N, Ragonnet B, et al. Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure: Need for a cautious use. Crit Care 2012;16(5):R188. DOI: 10.1186/cc11672.
Mirabel M, Celermajer D, Beraud AS, Jouven X, Marijon E, Hagège AA. Pocket-sized focused cardiac ultrasound: Strengths and limitations. Arch Cardiovasc Dis 2015;108(3):197–205. DOI: 10.1016/j.acvd.2015.01.002.
Cardim N, Dalen H, Voigt JU, Ionescu A, Price S, Neskovic AN, et al. The use of handheld ultrasound devices: A position statement of the European Association of Cardiovascular Imaging (2018 update). Eur Heart J Cardiovasc Imaging 2019;20(3):245–252. DOI: 10.1093/ehjci/jey145.
Andersen GN, Graven T, Skjetne K, Mjølstad OC, Kleinau JO, Olsen Ø, et al. Diagnostic influence of routine point-of-care pocket-size ultrasound examinations performed by medical residents. J Ultrasound Med 2015;34(4):627–636. DOI: 10.7863/ultra.34.4.627.
Barbier C, Loubières Y, Schmit C, Hayon J, Ricôme JL, Jardin F, et al. Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Med 2004;30(9):1740–1746. DOI: 10.1007/s00134-004-2259-8.
Minutiello L. Valutazione non invasiva della pressione venosa centrale (PVC) derivata dalle variazioni respiratorie del diametro della vena cava inferiore [Non-invasive evaluation of central venous pressure derived from respiratory variations in the diameter of the inferior vena cava]. Minerva Cardioangiol 1993;41(10):433–437. Italian. PMID: 8302439.
Fukuda S, Shimada K, Kawasaki T, Fujimoto H, Maeda K, Inanami H, et al. Pocket-sized transthoracic echocardiography device for the measurement of cardiac chamber size and function. Circ J 2009;73(6):1092–1096. DOI: 10.1253/circj.cj-08-1076.
Stock KF, Klein B, Steubl D, Lersch C, Heemann U, Wagenpfeil S, et al. Comparison of a pocket-size ultrasound device with a premium ultrasound machine: Diagnostic value and time required in bedside ultrasound examination. Abdom Imaging 2015;40(7):2861–2866. DOI: 10.1007/s00261-015-0406-z.
Filipiak-Strzecka D, Kasprzak JD, Lipiec P. Integrated assessment of heart, lung and lower extremity veins using hand-held ultrasound device in COVID-19 patients: Feasibility and clinical application. Diagnostics (Basel) 2023;13(4):724. DOI: 10.3390/diagnostics13040724.
Platz E, Pivetta E, Merz AA, Peck J, Rivero J, Cheng S. Impact of device selection and clip duration on lung ultrasound assessment in patients with heart failure. Am J Emerg Med 2015;33(11):1552–1556. DOI: 10.1016/j.ajem.2015.06.002.
Orso D, Paoli I, Piani T, Cilenti FL, Cristiani L, Guglielmo N. Accuracy of ultrasonographic measurements of ınferior vena cava to determine fluid responsiveness: A systematic review and meta-analysis. J Intensive Care Med 2020;35(4):354–363. DOI: 10.1177/0885066617752308.
Chowdhury SR, Datta PK, Maitra S, Rawat D, Baidya DK, Roy A, et al. The use of preoperative inferior vena cava ultrasound to predict anaesthesia-induced hypotension: A systematic review. Anaesthesiol Intensive Ther 2023;55(1):18–31. DOI: 10.5114/ait.2023.125310.
