Inferior Vena Cava Measurement with Ultrasound: What Is the Best View and Best Mode?

Publisher: Department of Emergency Medicine, University of California, Irvine Country of Publication: United States NLM ID: 101476450 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1936-9018 (Electronic) Linking ISSN: 1936900X NLM ISO Abbreviation: West J Emerg Med Subsets: MEDLINE

Publication: <2011>- : Irvine, CA : Department of Emergency Medicine, University of California, Irvine
Original Publication: Orange, CA : California Chapter of the American Academy of Emergency Medicine

Point-of-Care Systems*; Ultrasonography/*standards ; Vena Cava, Inferior/*diagnostic imaging; Adult ; Critical Care ; Healthy Volunteers ; Humans ; Observer Variation ; Prospective Studies ; Reproducibility of Results

Competing Interests: Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.
Introduction: Intravascular volume status is an important clinical consideration in the management of the critically ill. Point-of-care ultrasonography (POCUS) has gained popularity as a non-invasive means of intravascular volume assessment via examination of the inferior vena cava (IVC). However, there are limited data comparing different acquisition techniques for IVC measurement by POCUS. The goal of this evaluation was to determine the reliability of three IVC acquisition techniques for volume assessment: sub-xiphoid transabdominal long axis (LA), transabdominal short axis (SA), and right lateral transabdominal coronal long axis (CLA) (aka "rescue view").
Methods: Volunteers were evaluated by three experienced emergency physician sonographers (EP). Gray scale (B-mode) and motion-mode (M-mode) diameters were measured and IVC collapsibility index (IVCCI) calculated for three anatomic views (LA, SA, CLA). For each IVC measurement, we calculated descriptive statistics, intra-class correlation coefficients (ICC), and two-way univariate analyses of variance.
Results: EPs evaluated 39 volunteers, yielding 351 total US measurements. Measurements of the three views had similar means (LA 1.9 ± 0.4cm; SA 1.9 ± 0.4cm; CLA 2.0 ± 0.5cm). For B-Mode, LA had the highest ICC (0.86, 95% CI [0.76-0.92]) while CLA had the poorest ICC (0.74, 95% CI [0.56-0.85]). ICCs for all M-mode IVCCI were low. Significant interaction effects between anatomical view and EP were observed for B-mode and M-mode measurements. Post-hoc analyses revealed difficulty in consistent view acquisition between EPs.
Conclusion: Inter-rater reliability of the IVC by EPs was highest for B-mode LA and poorest for all M-Mode IVC collapsibility indices (IVCCI). These results suggest that B-mode LA holds the most promise to deliver reliable measures of IVC diameter. Future studies may focus on validation in a clinical setting as well as comparison to a reference standard.

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Date Created: 20170425 Date Completed: 20180213 Latest Revision: 20220311

20250114

PMC5391901

10.5811/westjem.2016.12.32489

28435502