Evaluation of the circulatory dynamics via observation of the inferior vena cava using ultrasonography

DOI 66 References
  • Kameda Toru
    Department of Emergency Medicine, Red Cross Society Azumino Hospital
  • Isaka Akira
    Department of Emergency Medicine, Red Cross Society Azumino Hospital
  • Fujita Masato
    Department of Emergency Medicine, Red Cross Society Azumino Hospital
  • Lu Zhaoyuan
    Department of Emergency Medicine, Red Cross Society Azumino Hospital
  • Ippongi Kuniharu
    Department of Emergency Medicine, Red Cross Society Azumino Hospital

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Other Title
  • 超音波検査を用いた下大静脈の観察による循環動態の評価

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Ultrasonography (US) is now readily available in emergency departments and intensive care units, and observing the inferior vena cava (IVC) with point-of-care US has become widely used to evaluate the circulatory dynamics. It is important to know about factors influencing the IVC diameter (IVCD) during the observation with US. In stable patients, the IVCD is usually measured in the supine position, however, reassessing it in the left lateral position is recommended in some cases. A sniff is appropriate for the evaluation of the respiratory response of the IVC. The measurement should generally be made at the hepatic segment and approximately 0.5 to 3 cm proximal to the ostium of the right atrium. The longitudinal view of the IVC is selected for the actual measurement, but understanding the shape in a cross-sectional view beforehand is helpful. The B- or M-mode should be used properly after considering the characteristics of each mode. As a substitute during the actual measurement, visual assessment of the IVC is also valuable, especially in critically-ill patients, because it can be quickly performed. The right atrial pressure is estimated based on the combination of the IVCD and its respiratory collapsibility in daily practice. The criteria used for estimating the right atrial pressure in Western countries have been revised in recent years. Meanwhile, the IVCD and indices of its respiratory changes have also been reported to be useful for the diagnosis and fluid management of decompensated heart failure, as well as for estimating circulatory volume depletion in early resuscitation and fluid responsiveness during controlled ventilation. Adding the observation of the IVC with point-of-care US in the acute care setting may thus enable physicians to perform less invasive and more accurate fluid therapy. Further evaluations based on standardized measurements and criteria are needed to confirm the utility of this modality.

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