Inferior Vena Cava Dispensability Index versus Central Venous Pressure in Volume Status Assessment in Shocked Patients

Abstract

Background: The central venous pressure [CVP] remains the most frequently used variable to guide fluid resuscitation in shocked patients and is considered a direct measurement of the blood pressure in the right atrium and vena cava. The ultrasound-guided measurement of the inferior vena cava [IVC] and its changes with respiration has recently been utilized to calculate a patient's fluid status.The Aim of the work: This work aimed to compare ultrasound guided inferior vena cava dispensability index to central venous pressure in shocked patients and to assess the volume status in shocked patients after measurement of CVP and IVC dispensability index [IVC DI].Patients and Methods: The study was conducted on 60 shocked patients, who were selected from the ICU, Al-Azhar University Hospitals.Results: At cutoff point 7.5 cmH2O, CVP has a sensitivity of 97% and specificity of 96.3% for prediction of hypovolemia. Also, at cutoff point 15.5, IVC-DI has sensitivity of 93.9% and specificity of 100% to predict hypovolemia. In addition, CVP at cutoff point 8.5 cmH2O has sensitivity of 50% and specificity of 55% for predicting fluid responsiveness. Also, at cutoff point 14.5 IVC DI has sensitivity of 100% and specificity of 91.9% for predicting fluid responsiveness.Conclusion: Ultrasound guided CVP and IVC DI were reliable markers in predicting fluid responsiveness and hypovolemia among shocked patients. IVC DI was superior than central CVP.

Keywords

• ultrasound
• inferior vena cava
• dispensability index
• venous pressure
• shock