Usefulness of Respiratory Variation of Inferior Vena Cava Diameter for Estimation of Elevated Central Venous Pressure in Children With Cardiovascular Disease

Abstract

Background:The purpose of the present study was to determine the relationship of inferior vena cava diameter (IVCD) and its respirophasic variation (IVC collapsibility index: IVCCI) with central venous pressure (CVP), and thereby to provide reference cut-offs for such IVC parameters to estimate elevation in CVP in pediatric patients with cardiovascular disease. Methods and Results:The study involved consecutive pediatric patients (n=118) with various heart diseases who either had a central venous catheter in the cardiac intensive care unit or underwent cardiac catheterization. The maximum (IVCDmax) and minimum (IVCDmin) diameters of IVC were measured on ultrasound simultaneously with measurements of mean CVP. IVCDmax, IVCDmin and IVCCI correlated significantly with CVP (R 2 =0.26, 0.47 and 0.41, respectively) in spontaneously breathing patients, but not in mechanically ventilated patients. Receiver operator characteristic curve analysis indicated that IVCCI under spontaneous breathing had the best area under the curve, with sensitivity of 1.0 and specificity of 0.98 for a cut-off of 0.22 to predict elevated CVP ≥10 mmHg.Conclusions: IVCCI seems to be a useful and accurate non-invasive index for estimation of elevated CVP in pediatric patients with cardiovascular disease. (Circ J 2011; 75: 1209 - 1214

Estimation of Right Atrial Pressure on Inferior Vena Cava Ultrasound in Asian Patients

“…It is unlikely that the present patients were dehydrated because cardiac output and IVCD were preserved, as shown in Table 1. The present relatively low RAP further supports the existing data in Japanese children with congenital heart disease reported by Iwamoto et al 2 A lower RAP compared with Western populations 3,6,12 might be one of the characteristics of …”

Respirophasic Variation of IVC Diameter in Mechanically Ventilated Patients With Cardiovascular Disease

“…We did not standardize the ventilatory setting during the measurements, and this could have, to some extent, contributed to the variations in the data of mechanically ventilated patients. 1 On the other hand, we had found in our preliminary study that increasing the PIP over 20 mmHg, to maximize cardiopulmonary interaction, minimally affected IVCCI regardless of CVP level. This is also consistent with data reported by Dr Moretti and coworkers, 2 suggesting a significant overlap in the CVP -IVCCI relationship even under the standardized ventilatory setting (data in Table 1 of their paper); the mean IVCCI under the standardized ventilatory setting with PEEP of 0 mmHg and tidal volume of 8 ml/kg was very low and a difference of 6% in IVCCI corresponds to a difference in only 2 mmHg of CVP.…”

Respirophasic Variation of IVC Diameter in Mechanically Ventilated Patients With Cardiovascular Disease

“…In a recent study, Iwamoto et al found a good correlation between the ultrasonographic measurement of the respiratory variation of the inferior vena cava diameter (IVCD) and central venous pressure (CVP) in spontaneously breathing children with hearth disease, but could not find the same correlation in mechanically ventilated patients. 1 Following this observations, it is worth pointing out our interest towards 2 basic concepts of the use of the IVCD and its derived variables.…”

“…In order to amplify cardiopulmonary interactions, regardless of the baseline ventilation setting, measurements of arterial waveformderived variables tend to be taken with a positive endexpiratory pressure of ≤5 cmH2O and a tidal volume of 8-10 ml/kg. 2 A similar protocol has been proposed in studies where the IVCD respiratory variation was examined as a preload index, 3 whereas the ventilation parameters were not mentioned by Iwamoto et al 1 Furthermore, intrathoracic pressure variations during the respiratory cycle are strictly dependent on the compliance of the respiratory system: the higher the compliance, as in most pediatric patients, the higher the intrathoracic pressure and the hemodynamic effects of ventilation. 4 2.…”