Influence of head‐of‐bed elevation on the measurement of inferior vena cava diameter and collapsibility
| Autor: | Angela Love, Adam Rothman, Pierre Kory, Young Im Lee, Navitha Ramesh, Eric Bondarsky |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Supine position Critical Care Critical Illness Posture Population Vena Cava Inferior Respiratory physiology 030204 cardiovascular system & hematology Inferior vena cava Patient Positioning 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Intravascular volume status Humans Medicine Radiology Nuclear Medicine and imaging Prospective Studies education Aged Ultrasonography Intracranial pressure education.field_of_study business.industry Ultrasound medicine.vein Breathing Female business Nuclear medicine |
| Zdroj: | Journal of Clinical Ultrasound. 48:249-253 |
| ISSN: | 1097-0096 0091-2751 |
| Popis: | Purpose Inferior vena cava (IVC) diameter and variation are commonly measured in the supine position to estimate intravascular volume status of critically ill patients. Many scientific societies describe the measurement of IVC diameter in the supine position. However, critically ill patients are rarely placed supine due to concerns for aspiration risk, worsened respiratory mechanics, increases in intracranial pressure, and the time it takes to change patient position. We assessed the influence of head-of-bed (HOB) elevation on IVC measurements. Methods We conducted a prospective observational study of critically ill patients undergoing critical care ultrasound. With HOB at 0°, IVC maximum (IVCmax0°) and minimum (IVCmin0°) diameters were measured. Measurements were then repeated with HOB elevated to 30° and 45°. Collapsibility index (CI), defined as (IVCmax - IVCmin)/IVCmax, was calculated for each HOB elevation. Mean differences were then compared. Results A convenience sample of 95 patients was studied, of whom 45% were on vasopressors and 44% were spontaneously breathing. The CI did not significantly differ between the three positions. We found a significant difference (P ≤ .0001) between IVCmax at 45° (2.09 cm) and 0° (1.96 cm), IVCmin at 45° (1.75 cm) and 0° (1.59 cm), IVCmax at 45° (2.09 cm) and 30° (1.97 cm), and IVCmin at 45° (1.75 cm) and 30° (1.61 cm). Conclusions In a population of critically ill patients undergoing goal-directed ultrasound examinations, elevating HOB to 30° did not significantly alter IVC measurements or CI. At 45°, however, IVCmax and IVCmin diameters increased significantly, albeit with no significant change in CI. Performing ultrasound measurements of the IVC with HOB elevated to 30° is unlikely to produce clinically meaningful changes. |
| Databáze: | OpenAIRE |
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