Open Access Emergency Medicine (Aug 2021)
Sonographic Estimation Rather Than Quantification of Fluid Status Using Inferior Vena Cava and Other Major Vessel Parameters in a Non-Bleeding Fluid Loss and Centralization Model
Abstract
Andreas Fichtner,1,2 Benedikt Brunner,3 Enrico Kloemich,1 Thomas Grab,4 Thomas Pohl,4 Tobias Fieback4 1Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Saxony, Germany; 2Emergency Department, Freiberg Hospital, Freiberg, Saxony, Germany; 3University of Gothenburg, Department of Marine Sciences, Gothenburg, Sweden; 4Scientific Diving Center, Bergakademie Freiberg, Freiberg, Saxony, GermanyCorrespondence: Andreas FichtnerEmergency Department, Freiberg Hospital, Donatsring 20, Freiberg, 09599, Saxony, GermanyTel +49-3731-772198Email [email protected]: A well-accepted step in emergency sonography is the estimation of a fluid deficit through Inferior Vena Cava (IVC) diameter variability with known cut-offs especially in bleeding. We sought to answer, whether a non-bleeding fluid deficit can be quantified through sonographic assessment of IVC diameter variability and related aortic parameters. Sport divers were used as human hypovolemic vasoconstriction models since immersion is known to cause relevant volume depletion through vasoconstriction and induced diuresis.Materials and Methods: Forty-one sport divers performed 342 single and repetitive dives to account for intra- and interindividual variability and were assessed for inferior Vena Cava and neighboring aortic diameters as well as their cardiac/respiratory variations. Dive-related weight loss was measured together with sonographic vessel diameter changes inferior to the right atrium.Results: Highest correlation with dive-related weight loss of max. 2.9 kg per an average 47 minutes dive was found with r=0.34 for the difference of IVC maximum diameter related to minimum Aortic diameter. Single or combined parameters, as well as Collapsibility Index, showed lower or no correlations. Vascular parameters were able to explain 7.5% of the variance of fluid losses, whereas interindividual effects explained 10%. The remaining 82.5% is of mixed intraindividual counterregulatory effects.Conclusion: IVC diameter changes in immersion-induced hypovolemic centralization provides qualitative information on relevant fluid loss only. Confounding factors like inter and intraindividual variability prevent a sufficient correlation for useful quantification of the experienced non-bleeding fluid deficit in the clinical setting.Keywords: emergency sonography, fluid status, IVC-parameters, caval index
