Emergency Department Bedside Ultrasonographic Measurement of the Caval Index for Noninvasive Determination of Low Central Venous Pressure

Arun D. Nagdev, Roland C. Merchant, Alfredo Tirado-Gonzalez, Craig Sisson, Michael C. Murphy

Research output: Contribution to journalArticle

163 Citations (Scopus)

Abstract

Study objective: Among adult emergency department (ED) patients undergoing central venous catheterization, we determine whether a greater than or equal to 50% decrease in inferior vena cava diameter is associated with a central venous pressure of less than 8 mm Hg. Methods: Adult patients undergoing central venous catheterization were enrolled in a prospective, observational study. Inferior vena cava inspiratory and expiratory diameters were measured by 2-dimensional bedside ultrasonography. The caval index was calculated as the relative decrease in inferior vena cava diameter during 1 respiratory cycle. The correlation of central venous pressure and caval index was calculated. The sensitivity, specificity, and positive and negative predictive values of a caval index greater than or equal to 50% that was associated with a central venous pressure less than 8 mm Hg were estimated. Results: Of 73 patients, the median age was 63 years and 60% were women. Mean time and fluid administered from ultrasonographic measurement to central venous pressure determination were 6.5 minutes and 45 mL, respectively. Of the 73 participants, 32% had a central venous pressure less than 8 mm Hg. The correlation between caval index and central venous pressure was -0.74 (95% confidence interval [CI] -0.82 to -0.63). The sensitivity of caval index greater than or equal to 50% to predict a central venous pressure less than 8 mm Hg was 91% (95% CI 71% to 99%), the specificity was 94% (95% CI 84% to 99%), the positive predictive value was 87% (95% CI 66% to 97%), and the negative predictive value was 96% (95% CI 86% to 99%). Conclusion: Bedside ultrasonographic measurement of caval index greater than or equal to 50% is strongly associated with a low central venous pressure. Bedside measurements of caval index could be a useful noninvasive tool to determine central venous pressure during the initial evaluation of the ED patient.

Original languageEnglish (US)
Pages (from-to)290-295
Number of pages6
JournalAnnals of Emergency Medicine
Volume55
Issue number3
DOIs
StatePublished - Mar 2010
Externally publishedYes

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Venae Cavae
Central Venous Pressure
Hospital Emergency Service
Confidence Intervals
Inferior Vena Cava
Central Venous Catheterization
Observational Studies
Ultrasonography
Prospective Studies
Sensitivity and Specificity

ASJC Scopus subject areas

  • Emergency Medicine

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Emergency Department Bedside Ultrasonographic Measurement of the Caval Index for Noninvasive Determination of Low Central Venous Pressure. / Nagdev, Arun D.; Merchant, Roland C.; Tirado-Gonzalez, Alfredo; Sisson, Craig; Murphy, Michael C.

In: Annals of Emergency Medicine, Vol. 55, No. 3, 03.2010, p. 290-295.

Research output: Contribution to journalArticle

Nagdev, Arun D. ; Merchant, Roland C. ; Tirado-Gonzalez, Alfredo ; Sisson, Craig ; Murphy, Michael C. / Emergency Department Bedside Ultrasonographic Measurement of the Caval Index for Noninvasive Determination of Low Central Venous Pressure. In: Annals of Emergency Medicine. 2010 ; Vol. 55, No. 3. pp. 290-295.
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abstract = "Study objective: Among adult emergency department (ED) patients undergoing central venous catheterization, we determine whether a greater than or equal to 50{\%} decrease in inferior vena cava diameter is associated with a central venous pressure of less than 8 mm Hg. Methods: Adult patients undergoing central venous catheterization were enrolled in a prospective, observational study. Inferior vena cava inspiratory and expiratory diameters were measured by 2-dimensional bedside ultrasonography. The caval index was calculated as the relative decrease in inferior vena cava diameter during 1 respiratory cycle. The correlation of central venous pressure and caval index was calculated. The sensitivity, specificity, and positive and negative predictive values of a caval index greater than or equal to 50{\%} that was associated with a central venous pressure less than 8 mm Hg were estimated. Results: Of 73 patients, the median age was 63 years and 60{\%} were women. Mean time and fluid administered from ultrasonographic measurement to central venous pressure determination were 6.5 minutes and 45 mL, respectively. Of the 73 participants, 32{\%} had a central venous pressure less than 8 mm Hg. The correlation between caval index and central venous pressure was -0.74 (95{\%} confidence interval [CI] -0.82 to -0.63). The sensitivity of caval index greater than or equal to 50{\%} to predict a central venous pressure less than 8 mm Hg was 91{\%} (95{\%} CI 71{\%} to 99{\%}), the specificity was 94{\%} (95{\%} CI 84{\%} to 99{\%}), the positive predictive value was 87{\%} (95{\%} CI 66{\%} to 97{\%}), and the negative predictive value was 96{\%} (95{\%} CI 86{\%} to 99{\%}). Conclusion: Bedside ultrasonographic measurement of caval index greater than or equal to 50{\%} is strongly associated with a low central venous pressure. Bedside measurements of caval index could be a useful noninvasive tool to determine central venous pressure during the initial evaluation of the ED patient.",
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AU - Murphy, Michael C.

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