The Right Subclavian Vein Can Be Used as a Surrogate of the Inferior Vena Cava, as an Echocardiographic Indicator of Systemic Venous Congestion

Ahmad, Mahmood; D’Cruz, Ivan A.; Minderman, Daniel; Shelton, Michela

doi:10.1097/maj.0b013e3180533fa1

Cited by 4 publications

(18 citation statements)

References 7 publications

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“…Our findings were comparable to data extracted and analyzed from two other medical or surgical populations ( Figure 2E to 2H and Table 2). 13,16 In our study, the SCV CI cut-off value, corresponding to the IVC CI cut-off of <20% for hypervolemia, was SCV CI <22% for both spontaneous breathing and mechanically ventilated encounters. The comparable SCV CI cut-off derived for data from Kent et al, 13 for a combination of spontaneously breathing and mechanically ventilated patients in the surgical ICU, was <23% ( Figure 2E and Table 2) and, for data from Munir et al 16 for spontaneously breathing patients receiving echocardiography studies, was higher at <32% ( Figure 2F and Table 2); the latter difference may be due to the widely scattered and smaller data set.…”

Section: Discussionmentioning

confidence: 52%

“…In our study, the SCV CI cut-off corresponding to the IVC CI cut-off of >50% for hypovolemia, was SCV CI >39% for both spontaneous breathing and mechanically ventilated encounters. A comparable SCV CI cut-off was >40% for data from Kent et al 13 and was >39% for data from Munir et al 16 ( Figure 2G and 2H and Table 2). The SCV CI cut-offs being lower than IVC CI cut-offs in our study and that of Munir et al 16 may relate to the patients' semi-recumbent position at 30 to 45 degrees.…”

Section: Discussionmentioning

confidence: 55%

“…5 One small study of subjects undergoing echocardiography for various clinical indications, showed a correlation of IVC variation while supine with SCV variation when semi-recumbent during spontaneous breathing. 16 Another study of surgical intensive care unit patients during spontaneous breathing or on mechanical ventilation (positions not specified), indicated a good correlation of IVC and SCV variations. 13 The purpose of this study is to assess the relationship between SCV and IVC respiratory variations by bedside ultrasound in a large group of hospitalized patients with acute and/or chronic kidney disease.…”

Section: Introductionmentioning

confidence: 98%

“…Sensitivity and specificity plots for various SCV CI cut-offs as predictors for whether IVC CI is <20% for spontaneous breathing encounters (A), <20% for mechanically ventilated encounters (B), >50% for spontaneous breathing encounters (C), >50% for mechanically ventilated encounters (D). Sensitivity and specificity plots for various SCV CI cut-offs from data derived from published reports, as predictors for whether IVC CI is <20% for spontaneous breathing encounters for medical patients (Munir et al 16 ) (E), <20% for spontaneous breathing and mechanically ventilated encounters for surgical ICU patients (Kent et al 13 ) (F), >50% for spontaneous breathing encounters for medical patients (Munir et al 16 ) (G), and >50% for a combination of spontaneous breathing and mechanically ventilated encounters for surgical ICU patients (Kent et al 13 ) (H). For the data from Munir et al, 16 collapsibility index ((max-min)/max) *100% was derived from (1-the ratio of min/max) for both SCV CI and IVC CI.…”

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confidence: 99%

“…g Data were extracted and transformed from published figures. For the data from Munir et al, 16 collapsibility index ((max-min)/max) was derived from (1-the ratio of min/max) for both SCV CI and IVC CI. +LR is likelihood of a positive result for a positive patient/likelihood of a positive result for negative patient eg for a +LR >5.0, a positive result is 5 times more likely to be a true positive rather than a false positive.…”

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confidence: 99%

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<p>Comparison of Respiratory Variations of Subclavian Vein and Inferior Vena Cava in Hospitalized Patients with Kidney Disease</p>

Kaptein¹,

Cantillep²,

Kaptein³

et al. 2020

IJNRD

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Background Accurate assessment of relative intravascular volume is critical for appropriate volume management of patients with kidney disease. Respiratory variations of inferior vena cava (IVC) diameter have been used and may correlate with those of subclavian vein (SCV) by bedside ultrasound. The purpose of this study was to assess the relationship between SCV and IVC respiratory variations by bedside ultrasound in a large group of hospitalized patients with acute and/or chronic kidney disease. Methods We compared 160 paired SCV and IVC bedside ultrasound studies from 102 semi-recumbent hospitalized adult patients with kidney disease. Patient encounters in which the SCV or IVC could not be clearly visualized were excluded. Collapsibility index=(Dmax–Dmin)/Dmax*100%; D=venous diameter. Results Relationships between SCV collapsibility index and IVC collapsibility index were not different for longitudinal and transverse views of the SCV. Correlation of SCV collapsibility index with IVC collapsibility index was 0.75 for mechanical ventilation (n=65, P<0.0001) and 0.67 for spontaneous breathing (n=95, P<0.0001). IVC collapsibility index cut-offs <20% for hypervolemia and >50% for hypovolemia corresponded to SCV collapsibility index cut-offs of <22% and >39%, respectively, for both mechanical ventilation and spontaneous breathing encounters. Using these cut-offs for SCV collapsibilities, assessment as hypervolemia versus not-hypervolemia had maximal sensitivity and specificity for predicting respective IVC collapsibility cut-offs of 88% for mechanical ventilation and 74% for spontaneous breathing, and assessment as hypovolemia versus not-hypovolemia had maximal sensitivity and specificity of 91% and 70%, respectively. Concordance, defined as agreement between assessment using SCV CI and assessment using IVC CI, was 85% for mechanical ventilation and 72% for spontaneous breathing when differentiating hypervolemia versus not-hypervolemia and was 89% and 71% respectively when differentiating hypovolemia versus not-hypovolemia. Conclusion Assessment using SCV collapsibility index in the semi-recumbent position has a reasonable concordance with assessment using IVC collapsibility index for both spontaneous breathing and mechanical ventilation, in a wide range of hospitalized patients with concurrent kidney disease, and may be a useful adjunct to assess relative intravascular volume in patients with kidney disease.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 55%

Section: Introductionmentioning

confidence: 98%

mentioning

confidence: 99%

mentioning

confidence: 99%

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<p>Comparison of Respiratory Variations of Subclavian Vein and Inferior Vena Cava in Hospitalized Patients with Kidney Disease</p>

Kaptein¹,

Cantillep²,

Kaptein³

et al. 2020

IJNRD

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Comparison of subclavian vein to inferior vena cava collapsibility by ultrasound in acute heart failure: A pilot study

Kaptein

2021

Clinical Cardiology

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Background: Management of acute decompensated heart failure (ADHF) requires accurate assessment of relative intravascular volume, which may be technically challenging. Inferior vena cava (IVC) collapsibility with respiration reflects intravascular volume and right atrial pressure (RAP). Subclavian vein (SCV) collapsibility may provide an alternative. Hypothesis:The purpose of this study was to examine the relationship between SCV collapsibility index (CI) and IVC CI in ADHF.Methods: This was a prospective study of non-ventilated patients with ADHF who had paired IVC and SCV ultrasound assessments. As SCV CI is highly positiondependent, measurements were performed supine at 30-45°.Results: Thirty-three patients were included with 36 encounters. The sample size was adequately powered for receiver-operator characteristic (ROC) analysis. SCV CI correlated with IVC CI during relaxed breathing (R = .65, n = 36, p < .001) and forced inhalation (R = .47, n = 36, p = .0036). SCV CI < 22% and >33% corresponded to IVC CI < 20% and >50% suggesting hypervolemia (sensitivity/specificity: 72%) and hypovolemia (sensitivity/specificity: 78%), respectively. Moderate to severe tricuspid regurgitation (TR) compared to less than moderate TR was associated with lower SCV CI (medians: 12.4% vs. 25.3%, p = .022) and IVC CI (medians: 9.6% vs. 35.6%, p = .0012). SCV CI and IVC CI were not significantly different among chronic kidney disease stages. Conclusion:In non-ventilated ADHF, SCV CI at 30-45°correlates with paired IVC CI, and may provide an alternative to IVC CI for assessment of relative intravascular volume, which may facilitate clinical management. Moderate to severe TR decreases SCV CI and IVC CI and may result in overestimation of relative intravascular volume.

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Inferior vena cava ultrasound and other techniques for assessment of intravascular and extravascular volume: an update

Kaptein

2023

Clinical Kidney Journal

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Goals of volume management are to accurately assess intravascular and extravascular volume and predict response to volume administration, vasopressor support, or volume removal. Data are reviewed that support the following: 1) Dynamic parameters reliably guide volume administration and may improve clinical outcomes compared to static parameters, but some are invasive or only validated with mechanical ventilation without spontaneous breathing. 2) Ultrasound visualization of inferior vena cava (IVC) diameter variations with respiration reliably assesses intravascular volume and predicts volume responsiveness. 3) Although physiology of IVC respiratory variations differs with mechanical ventilation and spontaneous breathing, IVC collapsibility index (CI) and distensibility index are interconvertible. 4) Prediction of volume responsiveness by IVC CI is comparable for mechanical ventilation and spontaneous breathing patients. 5) Respiratory variations of subclavian/proximal axillary and internal jugular veins by ultrasound are alternative sites, with comparable reliability. 6) Data support clinical applicability of IVC CI to predict hypotension with anesthesia, guide ultrafiltration goals, predict dry weight, predict intra-dialytic hypotension, and assess acute decompensated heart failure. 7) IVC ultrasound may complement ultrasound of heart, lungs, and abdominal organs for venous congestion, for assessing and managing volume overload and deresuscitation, renal failure, and shock. 8) IVC ultrasound has limitations including inadequate visualization. Ultrasound data should always be interpreted in clinical context. Additional studies are required to further assess and validate the role of bedside ultrasonography in clinical care.

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The Right Subclavian Vein Can Be Used as a Surrogate of the Inferior Vena Cava, as an Echocardiographic Indicator of Systemic Venous Congestion

Cited by 4 publications

References 7 publications

<p>Comparison of Respiratory Variations of Subclavian Vein and Inferior Vena Cava in Hospitalized Patients with Kidney Disease</p>

<p>Comparison of Respiratory Variations of Subclavian Vein and Inferior Vena Cava in Hospitalized Patients with Kidney Disease</p>

Comparison of subclavian vein to inferior vena cava collapsibility by ultrasound in acute heart failure: A pilot study

Inferior vena cava ultrasound and other techniques for assessment of intravascular and extravascular volume: an update

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