Initial inferior vena cava diameter on computed tomographic scan independently predicts mortality in severely injured trauma patients

Johnson, Jeremy J.; Garwe, Tabitha; Albrecht, Roxie M.; Adeseye, Ademola; Bishop, David G.; Fails, Robert; Shepherd, David W.; Lees, Jane

doi:10.1097/ta.0b013e3182827270

Cited by 29 publications

(49 citation statements)

References 14 publications

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“…Second, a separate cohort of patients was not used to identify the optimal cutoff for defining a flat IVC thereby potentially limiting the strength of our conclusions. However, the cutoff value identified is consistent with the results of previous studies, which have attempted to predict mortality or hemodynamic deterioration in trauma patients with a flat IVC [7,8].…”

Section: Discussionsupporting

confidence: 85%

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Flat or fat? Inferior vena cava ratio is a marker for occult shock in trauma patients

Nguyen

Plurad

Bricker

et al. 2014

Journal of Surgical Research

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Section: Discussionsupporting

confidence: 85%

“…IVC transverse and anteroposterior diameters were measured 2.5e5 mm above the left renal vein on axial tomographic views. A flat IVC was defined as a transverse-toanteroposterior ratio !2.5 at the level of the suprarenal IVC [7,8]. A fat IVC was defined as a transverse-to-anteroposterior ratio of <2.5.…”

Section: 3mentioning

confidence: 99%

Flat or fat? Inferior vena cava ratio is a marker for occult shock in trauma patients

Nguyen

Plurad

Bricker

et al. 2014

Journal of Surgical Research

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“…Some studies have attempted to relate the biometrics of the IVC with various clinical applications, especially in the field of IVC filters [12,14,15,23] and as an indirect assessment of intravascular volume [14,[24][25][26] . The majority of authors against migration, as two projections are not adequate to evaluate filter anchoring to the vein wall.…”

Section: Discussionmentioning

confidence: 99%

Influence of breathing movements and Valsalva maneuver on vena caval dynamics

Laborda

Sierre

Malvè

et al. 2014

WJR

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AIM:To study changes produced within the inferior vena cava (IVC) during respiratory movements and identify their possible clinical implications. METHODS:This study included 100 patients (46 women; 54 men) over 18 years of age who required an abdominal computed tomography (CT) and central venous access. IVC cross-sectional areas were measured on CT scans at three levels, suprarenal (SR), juxtarenal (JR) and infrarenal (IR), during neutral breathing and again during the Valsalva maneuver. All patients were instructed on how to perform a correct Valsalva maneuver. In order to reduce the total radiation dose in our patients, low-dose CT protocols were used in all patients. The venous blood pressure (systolic, diastolic and mean) was invasively measured at the same three levels with neutral breathing and the Valsalva maneuver during venous port implantation. From CT scans, threedimensional models of the IVC were constructed and a collapsibility index was calculated for each patient. These data were then correlated with venous pressures and cross-sectional areas. RESULTS:The mean patient age was 51.64 ± 12.01 years. The areas of the ellipse in neutral breathing were 394.49 ± 85.83 (SR), 380.10 ± 74.55 (JR), and 342.72 ± 49.77 mm 2 (IR), and 87.46 ± 18.35 (SR), 92.64 ± 15.36 (JR) and 70.05 ± 9.64 mm 2 (IR) during the Valsalva (P s < 0.001). There was a correlation between areas in neutral breathing and in the Valsalva maneuver (P < 0.05 in all areas). Large areas decreased more than smaller areas. The collapsibility indices were 0.49 ± 0.06 (SR), 0.50 ± 0.04 (JR) and 0.50 ± 0.04 (IR), with no significant differences in any region. Reconstructed three-dimensional models showed a flattening of the IVC during Valsalva, adopting an ellipsoid cross-sectional shape. The mean pressures with neutral breathing were 9.44 ± 1.78 (SR), 9.40 ± 1.44 (JR) and 8.84 ± 1.03 mmHg (IR), and 81.08 ± 21.82 (SR), 79.88 ± 19.01 (JR) and 74.04 ± 16.56 mmHg (IR) during Valsalva (P s < 0.001). There was a negative correlation between cross-sectional caval area and venous blood pressure, but this was not statistically significant in any of the cases. There was a significant correlation between diastolic and mean pressures measured during neutral breathing and in Valsalva. CONCLUSION:Respiratory movements have a major influence on IVC dynamics. The increase in intracaval pressure during Valsalva results in a significant de-

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“…We found that both ATH and CON had an equally shaped, slightly oval IVC at both expiration and inspiration and that the ratio of major diameter to minor diameter at maximal area exceeded 2.0 in only one subject. These findings could be of interest as the role of IVC shape in the diagnosis of and prognosis for trauma patients (Johnson et al 2013;Matsumoto et al 2010), as well as hemodialysis patients (Naruse et al 2007), is emerging. To our knowledge, however, normal IVC shape in healthy persons has not yet been determined.…”

Section: Ivc Shape and Respiratory Decrease In Dimensionsmentioning

confidence: 89%

Echocardiographic Characterization of the Inferior Vena Cava in Trained and Untrained Females

Hedman

Nylander

Henriksson

et al. 2016

Ultrasound in Medicine & Biology

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The aim of the study was to explore the long- and short-axis dimensions, shape and collapsibility of the inferior vena cava in 46 trained and 48 untrained females (mean age: 21 ± 2 y). Echocardiography in the subcostal view revealed a larger expiratory long-axis diameter (mean: 24 ± 3 vs. 20 ± 3 mm, p < 0.001) and short-axis area (mean: 5.5 ± 1.5 vs. 4.7 ± 1.4 cm, p = 0.014) in trained females. IVC shape (the ratio of short-axis major to minor diameters) and the relative decrease in IVC dimension with inspiration were similar for the two groups. The IVC long-axis diameter reflected short-axis minor diameter and was correlated to maximal oxygen uptake (r = 0.52, p < 0.01). In summary, the results indicate that trained females have a larger IVC similar in shape and respiratory decrease in dimensions to that of untrained females. The long-axis diameter corresponded closely to short-axis minor diameter and, thus, underestimates maximal IVC diameter.

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Initial inferior vena cava diameter on computed tomographic scan independently predicts mortality in severely injured trauma patients

Abstract: Prognostic study, level III.

Cited by 29 publications

References 14 publications

Flat or fat? Inferior vena cava ratio is a marker for occult shock in trauma patients

Flat or fat? Inferior vena cava ratio is a marker for occult shock in trauma patients

Influence of breathing movements and Valsalva maneuver on vena caval dynamics

Echocardiographic Characterization of the Inferior Vena Cava in Trained and Untrained Females

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