Assessment of the Intravascular Fluid Volume in Children by Point-of-Care Ultrasound
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Pediatrics, Procedures, Cardiovascular, 2022
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INTRODUCTION: Inferior Vena Cava (IVC) variability with respirations to assess dehydration has attained recognition in adults; however, there is inconclusive evidence for various dynamic parameters in predicting fluid responsiveness in children. This study was designed to assess the correlation of IVC variability and IVC/aortic ratio with clinical hydration assessment. The secondary objective was to correlate the ultrasound assessment of hydration with central venous pressure (CVP). METHODS: Prospective observational study in PICU (08/19 to 01/21) and included all children ( < 18 years) recruited after informed consent. IVC variability was assessed at the sub-costal (S.C.), and right lateral (R.L.) region and collapsibility index (C.I) (IVC max-IVC min/IVC Max) was calculated. IVC/Aortic ratio assessed in S.C. region in transverse view. Investigators were blinded to the hydration status of the patient. Up to 3 studies per enrolled patient on separate days. RESULTS: 145 ultrasounds were performed on 72 patients (median age of 67 months). 41% (n= 60) of the ultrasounds were performed on ventilated patients and 50% (n= 72) had central line in place. The majority (61%) were euvolemic, 10% were dehydrated, and 28% had fluid overload. Among spontaneously breathing patients, a significant difference was only observed in the median C.I at the S.C region based on hydration status (43% [IQR 39%, 52%], 30% [IQR 22%, 35%] and 21% [IQR 17%, 30%] for dehydrated, euvolemic and fluid overload patients, p < 0.01). For patients on positive pressure only median IVC/aortic ratio had a significant difference (0.68 [IQR 0.60, 1.3], 1.12 [IQR 0.94, 1.33] and 1.28 [IQR 1.2, 1.5] for the 3-hydration status). SC C.I also had the highest AUC (0.82) to detect dehydration in spontaneously breathing patients, with 80% sensitivity and 87% specificity for a cut-off of 40%. Both SC and R.L. C.I had a moderate correlation with each other (correlation coefficient 0.44 (95% CI 0.17, 0.65). Only significant correlation of CI was noted for R.L. C.I with CVP (-0.64 (95% CI -0.87, -0.20). CONCLUSION: C.I measured at S.C location  is a reliable measure to assess hydration status in spontaneously breathing children, while IVC/aortic ratio performs well for patients on positive pressure. C.I measured at R.L. region has a strong negative correlation with CVP.
Meta Tag
Content Type Presentation
Knowledge Area Pediatrics
Knowledge Area Procedures
Knowledge Area Cardiovascular
Knowledge Level Advanced
Membership Level Select
Tag Pediatrics
Tag Ultrasound
Tag Hemodynamic Monitoring
Tag Point of Care
Tag Cardiothoracic Critical Care
Year 2022
Tara Osman
advanced practice registered nurse
point-of-care ultrasound
intravascular fluid volume
hydration assessment


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