Normal inferior vena cava: caliber changes observed by dynamic ultrasound

Grant, E G; Rendano, F; Sevinç, Erkan; Gammelgaard, Jens; Holm, Hans Henrik; Grønvall, S

doi:10.2214/ajr.135.2.335

Cited by 63 publications

(44 citation statements)

References 5 publications

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“…All patients were trained to perform a Valsalva maneuver while the doctor kept his hand on the patient's abdomen to feel the contraction of the abdominal muscles. We noted that in women, abdominal contraction was not as remarkable as in men, coinciding with observations by Grant et al [1] , but there were not significant differences in calculated IVC area or in invasive venous pressures between the sexes. However, Valsalva maneuvers differ greatly depending on the patient.…”

Section: Discussionsupporting

confidence: 91%

“…There are few studies on the size of the IVC and its relationship to respiratory movements [1,2,10] or with central venous pressure [7,11,20] , and no studies correlating these data with the intravenous abdominal pressure. Using realhave concluded that three-dimensional CT is the most accurate method to study filter position and to assess safety Phlebography during the Valsalva maneuver that shows distribution of the contrast medium to renal and iliac veins; C: Computational study of inferior vena cava migration forces using an experimental set up and finite element simulation during the Valsalva maneuver.…”

Section: Discussionmentioning

confidence: 99%

“…In the medical literature, there is no agreement on whether the IVC increases or decreases in diameter during the Valsalva maneuver [1][2][3][4][5][6][7] . In a study on the diameter of the IVC measured by ultrasound, Grant et al [1] acknowledged this controversy and observed a decrease of IVC caliber during the Valsalva maneuver with a maximum increase at the end of the forced inspiration. Miraflor et al [8] attempted to relate IVC diameter and vascular filling (volume status) in hypotension, but did not observe a strong correlation.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Influence of breathing movements and Valsalva maneuver on vena caval dynamics

Laborda

Sierre

Malvè

et al. 2014

WJR

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“…Changes in intra-abdominal and intrathoracic pressures (e.g., during positive-pressure ventilation or Valsalva maneuver) are also well known to alter the CVP and have some effect on IVC diameters (41)(42)(43)(44). Our subject population was a mixture of patients receiving positive-pressure ventilation and those breathing spontaneously.…”

Section: Discussionmentioning

confidence: 99%

Does a Simple Bedside Sonographic Measurement of the Inferior Vena Cava Correlate to Central Venous Pressure?

Lorenzo

Morris

Williams

et al. 2012

The Journal of Emergency Medicine

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“…However, despite more than 30 years of interest in this parameter, there has been a lack of standardization across investigations. Studies have included healthy volunteers, 2 continuous ambulatory peritoneal dialysis patients, 3 hemodialysis patients, 4,5 healthy volunteers at phlebotomy centers, 6 and critically ill patients in intensive care units. 7,8 In addition, the locations of IVC measurements differ across studies [9][10][11][12][13][14][15][16][17][18][19] (Table 1).…”

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confidence: 99%

Inferior Vena Cava Percentage Collapse During Respiration Is Affected by the Sampling Location: An Ultrasound Study in Healthy Volunteers

Wallace

Allison

Stone

2010

Academic Emergency Medicine

150

109

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Objectives: Physicians are unable to reliably determine intravascular volume status through the clinical examination. Respiratory variation in the diameter of the inferior vena cava (IVC) has been investigated as a noninvasive marker of intravascular volume status; however, there has been a lack of standardization across investigations. The authors evaluated three locations along the IVC to determine if there is clinical equivalence of the respiratory percent collapse at these sites. The objective of this study was to determine the importance of location when measuring the IVC diameter during quiet respiration.Methods: Measurements of the IVC were obtained during quiet passive respiration in supine healthy volunteers. All images were recorded in B-mode, with cine-loop adjustments in real time, to ensure that maximum and minimum IVC dimensions were obtained. One-way repeated-measures analysis of variance (ANOVA) was used for comparison of IVC measurement sites.Results: The mean (±SD) percentage collapse was 20% (±16%) at the level of the diaphragm, 30% (±21%) at the level of the hepatic vein inlet, and 35% (±22%) at the level of the left renal vein. ANOVA revealed a significant overall effect for location of measurement, with F(2,35) = 6.00 and p = 0.006. Contrasts showed that the diaphragm percentage collapse was significantly smaller than the hepatic (F(1,36) = 5.14; p = 0.03) or renal caval index (F(1,36) = 11.85; p = 0.002).Conclusions: Measurements of respiratory variation in IVC collapse in healthy volunteers are equivalent at the level of the left renal vein and at 2 cm caudal to the hepatic vein inlet. Measurements taken at the junction of the right atrium and IVC are not equivalent to the other sites; clinicians should avoid measuring percentage collapse of the IVC at this location.ACADEMIC EMERGENCY MEDICINE 2010; 17:96-99 ª

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Normal inferior vena cava: caliber changes observed by dynamic ultrasound

Cited by 63 publications

References 5 publications

Influence of breathing movements and Valsalva maneuver on vena caval dynamics

Influence of breathing movements and Valsalva maneuver on vena caval dynamics

Does a Simple Bedside Sonographic Measurement of the Inferior Vena Cava Correlate to Central Venous Pressure?

Inferior Vena Cava Percentage Collapse During Respiration Is Affected by the Sampling Location: An Ultrasound Study in Healthy Volunteers

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