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VOLUME 21 , ISSUE 11 ( 2017 ) > List of Articles


The PCQP score for volume status of acutely ill patients: Integrating vascular pedicle width, caval index, respiratory variability of the qrs complex and R wave amplitude

Ali Taghizadieh, Kavous Nia, Payman Moharramzadeh, Mahboob Pouraghaei, Atefeh Ghavidel, Zahra Parsian

Keywords : Caval index, central venous pressure, changes in electrocardiographic wave, diameter of inferior vena cava, pulmonary vein pedicle

Citation Information : Taghizadieh A, Nia K, Moharramzadeh P, Pouraghaei M, Ghavidel A, Parsian Z. The PCQP score for volume status of acutely ill patients: Integrating vascular pedicle width, caval index, respiratory variability of the qrs complex and R wave amplitude. Indian J Crit Care Med 2017; 21 (11):726-732.

DOI: 10.4103/ijccm.IJCCM_275_17

License: CC BY-ND 3.0

Published Online: 01-01-2019

Copyright Statement:  Copyright © 2017; The Author(s).


Introduction: Techniques for measuring volume status of critically ill patients include invasive, less invasive, or noninvasive ones. The present study aims to assess the accuracy of noninvasive techniques for measuring volume status of critically ill patients. Patients and Methods: A total of 111 critically ill patients admitted to the emergency department and undergoing central venous catheterization were included in the study. Five parameters were measured including vascular pedicle width (VPW), diameter of inferior vena cava, caval index, respiratory changes in QRS, and P wave amplitude. Patients with risk factors which could decrease the accuracy of central venous pressure (CVP) value were excluded from study. We compared these parameters with static CVP parameter. Finally, based on the afore-mentioned parameters, PCQP role in criteria was designed. Results: In detecting loss of circulating blood volume, area under the curve of VPW was 0.92 (90%, confidence interval [CI]: 0.85–0.99), diameter of inferior vena cava was 0.82 (90%, CI: 0.72–0.91), caval index was 0.9 (90%, CI: 0.82–0.98), and changes in QRS an d P waves were 0.88 (95%, CI: 0.81–0.95) and 0.73 (95%, CI: 0.63–0.82), respectively. PCQP role in criteria was designed according to these parameters, and at its best cutoff point (score 6), VPW had a sensitivity of 97.4% (95%, CI: 84.57–99.99) and specificity of 83.6% (95%, CI: 72.65–90.86) for the detection of loss of circulating blood volume (<8 cmH2O). Conclusion: PCQP score could be a reliable and noninvasive technique for the assessment of volume status in critically ill patients.

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  1. Alsous F, Khamiees M, DeGirolamo A, Amoateng-Adjepong Y, Manthous CA. Negative fluid balance predicts survival in patients with septic shock: A retrospective pilot study. Chest 2000;117:1749-54.
  2. Maurer C, Wagner JY, Schmid RM, Saugel B. Assessment of volume status and fluid responsiveness in the emergency department: A systematic approach. Med Klin Intensivmed Notfmed 2017;112:326-33.
  3. Rivers EP, Coba V, Whitmill M. Early goal-directed therapy in severe sepsis and septic shock: A contemporary review of the literature. Curr Opin Anaesthesiol 2008;21:128-40.
  4. Gray AJ, Goodacre S, Newby DE, Masson MA, Sampson F, Dixon S, et al. Amulticentre randomised controlled trial of the use of continuous positive airway pressure and non-invasive positive pressure ventilation in the early treatment of patients presenting to the emergency department with severe acute cardiogenic pulmonary oedema: The 3CPO trial. Health Technol Assess 2009;13:1-06.
  5. Di Marco F, Tresoldi S, Maggiolini S, Bozzano A, Bellani G, Pesenti A, et al. Risk factors for treatment failure in patients with severe acute cardiogenic pulmonary oedema. Anaesth Intensive Care 2008;36:351-9.
  6. Salahuddin N, Aslam M, Chishti I, Siddiqui S. Determination of intravascular volume status in critically ill patients using portable chest X-rays: Measurement of the vascular pedicle width. Indian J Crit Care Med 2007;11:192-7.
  7. Ely EW, Haponik EF. Using the chest radiograph to determine intravascular volume status: The role of vascular pedicle width. Chest 2002;121:942-50.
  8. Ely EW, Smith AC, Chiles C, Aquino SL, Harle TS, Evans GW, et al. Radiologic determination of intravascular volume status using portable, digital chest radiography: A prospective investigation in 100 patients. Crit Care Med 2001;29:1502-12.
  9. Milne EN, Pistolesi M, Miniati M, Giuntini C. The vascular pedicle of the heart and the vena azygos. Part I: The normal subject. Radiology 1984;152:1-8.
  10. Wang H, Shi R, Mahler S, Gaspard J, Gorchynski J, D'Etienne J, et al. Vascular pedicle width on chest radiograph as a measure of volume overload: Meta-analysis. West J Emerg Med 2011;12:426-32.
  11. Goldflam K, Saul T, Lewiss R. Focus On: Inferior Vena Cava Ultrasound. Vol. 6. New York: ACEP News; 2011. p. 24-5.
  12. Joels CS, Sing RF, Heniford BT. Complications of inferior vena cava filters. Am Surg 2003;69:654-9.
  13. Vergara GR, Wallace WF, Bennett KR. Spontaneous migration of an inferior vena cava filter resulting in cardiac tamponade and percutaneous filter retrieval. Catheter Cardiovasc Interv 2007;69:300-2.
  14. Giraud R, Siegenthaler N, Morel DR, Romand JA, Brochard L, Bendjelid K, et al. Respiratory change in ECG-wave amplitude is a reliable parameter to estimate intravascular volume status. J Clin Monit Comput 2013;27:107-11.
  15. Murphy EH, Arko FR, Trimmer CK, Phangureh VS, Fogarty TJ, Zarins CK, et al. Volume associated dynamic geometry and spatial orientation of the inferior vena cava. J Vasc Surg 2009;50:835-42.
  16. Blehar DJ, Dickman E, Gaspari R. Identification of congestive heart failure via respiratory variation of inferior vena cava diameter. Am J Emerg Med 2009;27:71-5.
  17. Laher AE, Watermeyer MJ, Buchanan SK, Dippenaar N, Simo NCT, Motara F, et al. Areview of hemodynamic monitoring techniques, methods and devices for the emergency physician. Am J Emerg Med 2017;35:1335-47.
  18. Thomason JW, Ely EW, Chiles C, Ferretti G, Freimanis RI, Haponik EF, et al. Appraising pulmonary edema using supine chest roentgenograms in ventilated patients. Am J Respir Crit Care Med 1998;157:1600-8.
  19. Martin GS, Ely EW, Carroll FE, Bernard GR. Findings on the portable chest radiograph correlate with fluid balance in critically ill patients. Chest 2002;122:2087-95.
  20. Tayal V, Blaivas M. American College of Emergency Physicians: ACEP emergency ultrasound guidelines-2001. Ann Emerg Med 2009;53:470-81.
  21. Nagdev AD, Merchant RC, Tirado-Gonzalez A, Sisson CA, Murphy MC. Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure. Ann Emerg Med 2010;55:290-5.
  22. Sridhar H, Mangalore P, Chandrasekaran V, Manikam R. Caval aorta index and central venous pressure correlation in assessing fluid status!“Ultrasound Bridging the Gap”. ISRN Emerg Med 2012;2012:1-5.
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