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Ultrasound GuidedVolume Assessment
Starr Knight, M.D.HIGH RISK Hawaii
Feb 14, 2014
Outline
• IVC Ultrasound Technique
• Clinical Use of IVC Ultrasound
• Clinical Cases
IVC Ultrasound Exam
• Exam Technique
• Goals of the Exam
• Pitfalls
Probe Selection
Liver
IVC
RA
RA
Liver
IVC
Hypovolemia Hypervolemia
Hypovolemia Hypervolemia
The “Sniff” Test
Hypovolemia Hypervolemia
Caval Index
Ultrasound Protocols
• RUSH
• RADiUS
• Triple Scan
1. Cardiac Ultrasound
2. Lung Ultrasound
3. IVC Ultrasound
Goals of the Exam
Assess for Pulmonary Edema
Evaluate Pump Function
Interrogate IVC
Protocol
1. Cardiac Ultrasound
2. Lung Ultrasound
3. IVC Ultrasound
Clinical Cases
Septic
Before IVFs After 2L IVFs
CHF
Pulmonary Embolism
Cardiac Tamponade
Take Home Points
• Distinguish IVC from Aorta
• Eval IVC 2cm distal to RA-IVC junction
• Use in conjunction with Cardiac and Lung ULS
• Remember Conditions with ↑R Cardiac Pressure
• Serial Exams during resuscitation
References• Kircher BJ, Himelman RB, Schiller NB. Noninvasive estimation of right atrial pressure from the inspiratory
collapse of the inferior vena cava. Am J. Cardiol. 1990;66:493-6.• Tetsuka T, Ando Y, Ono S, Asano Y. Change in inferior vena cava diameter detected by ultrasonography during and
after hemodialysis. ASAIO J 1995;41:105 - 10• Randazzo MR, Snoey ER, Levitt MA, et al. Accuracy of emergency physician assessment of left ventricular
ejection fraction and central venous pressure using echocardiography. Acad. Emerg. Med.2003;10:973-7.• Feissel M, Michard F, Faller JP, et al. The respiratory variation in inferior vena cava diameter as a guide to fluid
therapy. Intensive Care Med. 2004;30:1834-7.• Barbier C, Loubieres Y, Schmit C, et al. Respiratorychanges in inferior vena cava diameter are helpful in
predicting fluid responsiveness in ventilated septic patients. Intensive Care Med. 2004; 30:1740–6.• Lyon M, Blaivas M, Brannam L.Sonographic measurement of the inferior vena cava as a marker of blood loss. Am
J Emerg Med. 2005 Jan;23(1):45-50.• Brennan JM, Ronan A, Goonewardena S, et al. Handcarried ultrasound measurement of the inferior vena cava for
assessment of intravascular volume status in the outpatient hemodialysis clinic. Clin J Am Soc Nephrol. 2006; 1:749–53.• Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of
the literature and the tale of seven mares. Chest. 2008 Jul;134(1):172-8.• Blehar DJ, Dickman E, Gaspari R. Identification of congestive heart failure via respiratory variation of inferior
vena cava diameter. Am. J. Emerg. Med. 2009;27:71-5.• Wallace DJ, Allison M, Stone MB. Inferior vena cava percentage collapse during respiration is affected by the
sampling location: an ultrasound study in healthy volunteers. Acad Emerg Med. 2010 Jan;17(1):96-9. Epub 2009 Dec 9.• Nagdev AD, Merchant RC, Tirado-Gonzalez A, et al. Emergency department bedside ultrasonographic
measurement of the caval index for noninvasive determination of low central venous pressure. Ann. Emerg. Med. 2010;55:290-5.• Fields JM, Lee PA, Jenq KY, et al. The interrater reliability of inferior vena cava ultrasound by bedside clinician
sonographers in emergency department patients. Acad. Emerg. Med. 2011;18:98-101.
References• Volpicelli G, Mussa A, Garofalo G, et al. Bedside lung ultrasound in the assessment of alveolar-
interstitial syndrome. Am J Emerg Med. Oct 2006;24(6):689-696.
• Parlamento S, Copetti R, Di Bartolomeo S. Evaluation of lung ultrasound for the diagnosis of pneumonia in the ED. Am J Emerg Med. May 2009;27(4):379-384.
• Cortellaro F, Colombo S, Coen D, et al. Lung ultrasound is an accurate diagnostic tool for the diagnosis of pneumonia in the emergency department. Emerg Med J. Oct 28 2010.
• Lichtenstein D, Meziere G, Biderman P, et al. The comet-tail artifact: an ultrasound sign ruling out pneumothorax. Intensive Care Med. Apr 1999;25(4):383-388.
• Lichtenstein D, Meziere G, Biderman P, et al. The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med. Nov 1997;156(5):1640-1646.
• Lichtenstein DA, Menu Y. A bedside ultrasound sign ruling out pneumothorax in the critically ill. Lung sliding. Chest. Nov 1995;108(5):1345-1348.
• Alrajhi K, Woo M, Vaillancourt C. Test Characteristics of Ultrasonography for the Detection of Pneumothorax. CHEST.141(3) MARCH 2012
• Wu Ding W, Yuehong S ,Yang J. Diagnosis of Pneumothorax by Radiography and Ultrasonography.CHEST.140 (4) OCTOBER, 2011
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