Emergency Medicine Sun 21 August 2022 Assessment of internal jugular vein and femoral vein collapsibility in the determination of intravascular volume status as compared to inferior vena cava collapsibility
Researcher : Gupta devansh
Research Guide : Sinha tej prakash
Institution Name : All india institute of medical sciences new delhi


Background: Accurate assessment of volume status and fluid requirement is of paramount importance for an emergency physician. Inferior Vena Cava collapsibility index (IVC-CI) has been studied extensively for intravascular volume status assessment and has been documented to correlate well with CVP and other markers of intravascular volume. However, IVC may not be visualised due to reasons such as morbid obesity, abdominal wounds, surgical dressings, abdominal tenderness, massive ascites, bowel gas overlying the IVC, mass causing external compression, among others. In our review of literature, we found that non-visualization of IVC was reported to range from 4.8% to 17.8%. Aim: Considering IVC-CI as “Gold Standard”, our primary objective was to assess the correlation between Internal Jugular Vein and Femoral Vein Collapsibility Indices with Inferior Vena Cava Collapsibility Index. Our secondary objective was to compare the time taken to measure collapsibility indices of Femoral vein, Internal Jugular Vein and Inferior Vena Cava. Settings and Design: Ours was a prospective observational study where we enrolled 75 adult spontaneously breathing patients in the emergency department of our institute. Materials and Methods: The study was conducted over 2 years. Data was collected under the headings of patient demographics, physical examination, lab data, sonographic measurements and time to data acquisition using a proforma. An average of 3 measurements of the ultrasonographic collapsibility indices of the IVC, IJV and FV was recorded in each patient and the time required to acquire images and record measurements was noted in each case. Recordings were made with the patients in supine position with head of bed elevation at 0 °. Statistical Analysis Used: Data was analysed using SPSS (24) and Stata. Spearman’s rank correlation coefficient was calculated to compare data obtained for Inferior Vena Cava, Femoral Vein and Internal Jugular Vein. ICC statistics was used to establish agreement. Coefficient of Variation was calculated for the datasets of IVC-CI, IJV CI and FV-CI. Value of p < 0.05 was considered as statistically significant. Results : In our study, we found that the correlation between the IVC-CI and IJV-CI with r = 0.34 (p value = 0.002), while statistically significant and positive, was weak. The intraclass correlation was found to be 0.491 (95% CI: 0.19 – 0.67). We found no correlation between FV-CI and IVC-CI (r = 0.18, p value = 0.12) with intraclass correlation found to be 0.107 (95% CI: -0.41-0.43). IJV-CI measurements took 23 seconds less time to acquire on average than their paired IVC-CI measurements. There was no statistical difference between the time required to acquire data of FV and IVC. Conclusions: From our study, we can conclude that Internal Jugular Vein collapsibility index may be a reasonable “second-line” alternative site for sonographic volume status assessment to IVC-CI in the patient in whom visualization of the latter is impossible. Further, IJV measurements took lesser time to acquire that IVC-CI measurements which may be useful in certain emergent clinical scenarios wherein a “quick look” assessment of IJV-CI may facilitate faster patient management with detailed examination being done after the patient is stabilized.

DOI: 1661108642   Year of publication: 2021

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