Volume assessment comparing femoral vein and inferior vena cava among chest pain patients presenting to the emergency department
Abstract Background Inferior vena cava (IVC) diameter measurement using ultrasound for volume status assessment has shown satisfactory results and is being adopted in Emergency and critical care settings. IVC diameter can vary depending on the cardiac function, respiratory efforts, intraabdominal pr...
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2024-11-01
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| Series: | International Journal of Emergency Medicine |
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| Online Access: | https://doi.org/10.1186/s12245-024-00762-7 |
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| author | Neeraja A Nair Freston Marc Sirur Vimal Krishnan S |
| author_facet | Neeraja A Nair Freston Marc Sirur Vimal Krishnan S |
| author_sort | Neeraja A Nair |
| collection | DOAJ |
| description | Abstract Background Inferior vena cava (IVC) diameter measurement using ultrasound for volume status assessment has shown satisfactory results and is being adopted in Emergency and critical care settings. IVC diameter can vary depending on the cardiac function, respiratory efforts, intraabdominal pressure, and mechanical ventilation. Due to these factors, IVC measurement cannot be considered a stand-alone technique appropriate for every patient. The femoral vein (FV), a more superficial vein than IVC, can be considered an alternative method for assessing fluid responsiveness in patients presenting to the Emergency department. It is easily accessible and can be used in scenarios where IVC cannot be visualized or reliable. Methods This was a single-center diagnostic study where 85 patients who presented to the ED with chest pain were enrolled prospectively. IVC and femoral vein collapsibility indices, stroke volume, and cardiac output are measured using an ultrasound machine. The measurements were repeated after a passive leg-raising test. These values were compared with each other to assess an intra-class correlation between IVC and femoral vein collapsibility indices. We have also evaluated the relationship between the collapsibility indices of both veins and cardiac output. Discussion & limitations Our findings show an insufficient correlation between IVC and FV collapsibility indices. However, both vein diameters significantly increased after passive leg raising (PLR), indicating a response to fluid challenge. Post-PLR reduced IVC, and FV collapsibility index (CI) suggests intravascular volume expansion after a fluid challenge, also reflected in the hemodynamic parameters. Our study was conducted only in a subset of relatively stable patients. The applicability of the study in different subsets of patients presenting to ED is still questionable. Conclusion We conclude that femoral vein indices may not be an accurate alternative for volume assessment in the chosen cohort of patients. IVC and FV metrics do not correlate and may not be accurate for volume responsiveness. We may need to explore the utility of FV and its indices in a larger population in multiple settings for a better understanding of its role in volume assessment and responsiveness. Trial registration (EC/NEW/INST/2021/1707). Registered 03 January 2023. |
| format | Article |
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| institution | Kabale University |
| issn | 1865-1380 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
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| series | International Journal of Emergency Medicine |
| spelling | doaj-art-a0ffb6c6bfd8426aa13d9937a8d3542a2024-12-01T12:08:24ZengBMCInternational Journal of Emergency Medicine1865-13802024-11-011711710.1186/s12245-024-00762-7Volume assessment comparing femoral vein and inferior vena cava among chest pain patients presenting to the emergency departmentNeeraja A Nair0Freston Marc Sirur1Vimal Krishnan S2Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), ManipalDepartment of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), ManipalDepartment of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), ManipalAbstract Background Inferior vena cava (IVC) diameter measurement using ultrasound for volume status assessment has shown satisfactory results and is being adopted in Emergency and critical care settings. IVC diameter can vary depending on the cardiac function, respiratory efforts, intraabdominal pressure, and mechanical ventilation. Due to these factors, IVC measurement cannot be considered a stand-alone technique appropriate for every patient. The femoral vein (FV), a more superficial vein than IVC, can be considered an alternative method for assessing fluid responsiveness in patients presenting to the Emergency department. It is easily accessible and can be used in scenarios where IVC cannot be visualized or reliable. Methods This was a single-center diagnostic study where 85 patients who presented to the ED with chest pain were enrolled prospectively. IVC and femoral vein collapsibility indices, stroke volume, and cardiac output are measured using an ultrasound machine. The measurements were repeated after a passive leg-raising test. These values were compared with each other to assess an intra-class correlation between IVC and femoral vein collapsibility indices. We have also evaluated the relationship between the collapsibility indices of both veins and cardiac output. Discussion & limitations Our findings show an insufficient correlation between IVC and FV collapsibility indices. However, both vein diameters significantly increased after passive leg raising (PLR), indicating a response to fluid challenge. Post-PLR reduced IVC, and FV collapsibility index (CI) suggests intravascular volume expansion after a fluid challenge, also reflected in the hemodynamic parameters. Our study was conducted only in a subset of relatively stable patients. The applicability of the study in different subsets of patients presenting to ED is still questionable. Conclusion We conclude that femoral vein indices may not be an accurate alternative for volume assessment in the chosen cohort of patients. IVC and FV metrics do not correlate and may not be accurate for volume responsiveness. We may need to explore the utility of FV and its indices in a larger population in multiple settings for a better understanding of its role in volume assessment and responsiveness. Trial registration (EC/NEW/INST/2021/1707). Registered 03 January 2023.https://doi.org/10.1186/s12245-024-00762-7POCUS (point of Care Ultrasound)Femoral vein Collapsibility IndexVolume assessmentInferior Vena CavaVolume responsivenessEmergency Department. |
| spellingShingle | Neeraja A Nair Freston Marc Sirur Vimal Krishnan S Volume assessment comparing femoral vein and inferior vena cava among chest pain patients presenting to the emergency department International Journal of Emergency Medicine POCUS (point of Care Ultrasound) Femoral vein Collapsibility Index Volume assessment Inferior Vena Cava Volume responsiveness Emergency Department. |
| title | Volume assessment comparing femoral vein and inferior vena cava among chest pain patients presenting to the emergency department |
| title_full | Volume assessment comparing femoral vein and inferior vena cava among chest pain patients presenting to the emergency department |
| title_fullStr | Volume assessment comparing femoral vein and inferior vena cava among chest pain patients presenting to the emergency department |
| title_full_unstemmed | Volume assessment comparing femoral vein and inferior vena cava among chest pain patients presenting to the emergency department |
| title_short | Volume assessment comparing femoral vein and inferior vena cava among chest pain patients presenting to the emergency department |
| title_sort | volume assessment comparing femoral vein and inferior vena cava among chest pain patients presenting to the emergency department |
| topic | POCUS (point of Care Ultrasound) Femoral vein Collapsibility Index Volume assessment Inferior Vena Cava Volume responsiveness Emergency Department. |
| url | https://doi.org/10.1186/s12245-024-00762-7 |
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