Evaluation of the Inferior Vena Cava Diameter in Dehydrated Children Using Bedside Ultrasonography

Abstract

Objective. Bedside ultrasonography (US) is a new imaging modality that has begun to be used in the Pediatric Emergency Unit to evaluate inferior vena cava (IVC) diameter for intravascular volume status. In this article, we aimed to evaluate IVC diameter with bedside US before and after the fluid therapy in dehydrated children. Methods. A total of 124 dehydrated patients were enrolled, aged 8 months to 17 years. The maximum diameters of the IVC and aorta (AO) were measured. IVC/AO ratio and IVC collapsibility index IVC–CI were calculated before and after the fluid therapy and correlation with the degree of dehydration and laboratory parameters was investigated. Results. Of the 124 patients, 49.2% (n = 61) were male, the mean age was 7.5 ± 4.94 years. The IVC/AOs ratio was increased in mild and moderate/severe groups after fluid therapy compared to before fluid administration. While the mean rate of heart rate, blood urea nitrogen (BUN), creatinine, and uric acid values were higher in the moderate/severe group, potassium and HCO3 were lower. There was no significant change in AO diameter and IVC–CI after fluid therapy in all groups. When the factors affecting the IVC/AOs ratio were analyzed with the logistic regression backward model; the IVC/AO ratio was found to increase as the degree of dehydration decreased (Adj.β = −0.318) and as the age (Adj.β = 0.242) and CRP (Adj.β = 0.186) value increased. Conclusion. The IVC/AO ratio can be a promising index for the assessment and grading of dehydration in children, and cutoff values that vary according to age are necessary for a more objective assessment of dehydration.

Point-of-care ultrasound to assess degree of dehydration in children: a systematic review with meta-analysis

“…Eleven studies with 2679 participants were included 13–23. Nine were full-text publications and two were conference abstracts.…”

“…Three studies13 18 23 including 436 participants assessed the POCUS measurement of IVC/Ao ratio compared with the clinical judgement. In the study by Chen et al, 13 participants were included when they had clinical evidence of dehydration and were judged to need IV fluids as determined by the emergency physician on duty.…”

“…In the study by Adewumi et al ,18 the study population comprised dehydrated patients as assessed by at least a senior physician. In the study by Özkan et al, 23 the grading of dehydration was performed by the attending clinician, blinded to the results of the ultrasound. The individual and summary results of the included studies are presented in figure 4 and figure 5.…”

“…Among the included studies, two were in abstract forms, which could have affected the quality of obtained data. Finally, while other methods of US assessment of dehydration exist (eg, IVC collapsibility index31 or IVC diameter23), they were not within the scope of this review.…”

Red Code Management in a Pediatric Emergency Department: A Retrospective Study

“…Unexpectedly, in our study, ultrasound was performed in only one-third of the patients, considering both bedside and specialistic exams: this could be, in part, attributed to the limited use of e-FAST US in polytrauma, which was more commonly managed through the execution of a CT scan, which provided pathological findings in a great portion of cases. The most frequently used US was the pleuropulmonary one, but we should implement the use of US as a component of the patient's primary assessment, especially in cases of hemodynamic instability, as it allows for the rapid evaluation of cardiac function and volume status, in accordance with ongoing international literature [3,[26][27][28].…”