The effect of continuous positive airway pressure on inferior vena cava collapsibility as measured by bedside ultrasound
Abstract Objectives The purpose of this study was to determine the impact of progressively increasing continuous positive airway pressure (CPAP) on measurements of the caval index (CI) using bedside ultrasound at the 3 common inferior vena cava (IVC) evaluation sites. Methods This was a prospective,...
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Elsevier
2022-12-01
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| Series: | Journal of the American College of Emergency Physicians Open |
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| Online Access: | https://doi.org/10.1002/emp2.12856 |
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| author | Jessica Solis‐McCarthy Christopher Gelabert Joel Michalek Craig Sisson |
| author_facet | Jessica Solis‐McCarthy Christopher Gelabert Joel Michalek Craig Sisson |
| author_sort | Jessica Solis‐McCarthy |
| collection | DOAJ |
| description | Abstract Objectives The purpose of this study was to determine the impact of progressively increasing continuous positive airway pressure (CPAP) on measurements of the caval index (CI) using bedside ultrasound at the 3 common inferior vena cava (IVC) evaluation sites. Methods This was a prospective, observational trial that included 165 healthy adults over 18 years old enrolled between February 2015 and May 2018. Measurements of the IVC were obtained during normal tidal respirations from the subxiphoid area in the long and short axis and from the right mid‐axillary line in the long axis. Measurements were obtained in each of these locations at atmospheric pressure and with CPAP at 5, 10, and 15 cmH2O. The CI was then calculated for each of the 3 selected locations at each level of pressure. Results As CPAP pressures increased from 0 to 15 cmH2O the CI measurements obtained at the lateral mid‐axillary line did not show any statistically significant variation. There was a statistically significant difference (P < 0.001) when comparing measurements of the CI from the lateral mid‐axillary line location to both anterior locations. As CPAP pressures increased, the CI calculated from the subxiphoid area in both the anterior short and anterior long axis orientations initially trended upwards at 5 cmH2O, then began to downtrend as the pressures increased to 10 and 15 cmH2O. Comparing the CI measurements from the anterior long and anterior short axis at 0, 5, 10, and 15 cmH2O, there was no statistically significant difference at any pressure (P > 0.05). Conclusion When evaluating the IVC in a spontaneously breathing patient, measurements from an anterior orientation are preferred as the lateral mid‐axillary view can underestimate CI calculations. |
| format | Article |
| id | doaj-art-22339f0ca32c4f988deef7d4e41195b1 |
| institution | OA Journals |
| issn | 2688-1152 |
| language | English |
| publishDate | 2022-12-01 |
| publisher | Elsevier |
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| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-22339f0ca32c4f988deef7d4e41195b12025-08-20T02:04:06ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522022-12-0136n/an/a10.1002/emp2.12856The effect of continuous positive airway pressure on inferior vena cava collapsibility as measured by bedside ultrasoundJessica Solis‐McCarthy0Christopher Gelabert1Joel Michalek2Craig Sisson3Division of Ultrasound Department of Emergency Medicine University of Texas Health San Antonio 7703 Floyd Curl Drive, MC 7736 San Antonio Texas USADivision of Ultrasound Department of Emergency Medicine University of Texas Health San Antonio 7703 Floyd Curl Drive, MC 7736 San Antonio Texas USADepartment of Population Health SciencesUniversity of Texas Health San Antonio San AntonioTexasUSADivision of Ultrasound Department of Emergency Medicine University of Texas Health San Antonio 7703 Floyd Curl Drive, MC 7736 San Antonio Texas USAAbstract Objectives The purpose of this study was to determine the impact of progressively increasing continuous positive airway pressure (CPAP) on measurements of the caval index (CI) using bedside ultrasound at the 3 common inferior vena cava (IVC) evaluation sites. Methods This was a prospective, observational trial that included 165 healthy adults over 18 years old enrolled between February 2015 and May 2018. Measurements of the IVC were obtained during normal tidal respirations from the subxiphoid area in the long and short axis and from the right mid‐axillary line in the long axis. Measurements were obtained in each of these locations at atmospheric pressure and with CPAP at 5, 10, and 15 cmH2O. The CI was then calculated for each of the 3 selected locations at each level of pressure. Results As CPAP pressures increased from 0 to 15 cmH2O the CI measurements obtained at the lateral mid‐axillary line did not show any statistically significant variation. There was a statistically significant difference (P < 0.001) when comparing measurements of the CI from the lateral mid‐axillary line location to both anterior locations. As CPAP pressures increased, the CI calculated from the subxiphoid area in both the anterior short and anterior long axis orientations initially trended upwards at 5 cmH2O, then began to downtrend as the pressures increased to 10 and 15 cmH2O. Comparing the CI measurements from the anterior long and anterior short axis at 0, 5, 10, and 15 cmH2O, there was no statistically significant difference at any pressure (P > 0.05). Conclusion When evaluating the IVC in a spontaneously breathing patient, measurements from an anterior orientation are preferred as the lateral mid‐axillary view can underestimate CI calculations.https://doi.org/10.1002/emp2.12856caval indexcontinuous positive airway pressureinferior vena cavapoint‐of‐care ultrasound |
| spellingShingle | Jessica Solis‐McCarthy Christopher Gelabert Joel Michalek Craig Sisson The effect of continuous positive airway pressure on inferior vena cava collapsibility as measured by bedside ultrasound Journal of the American College of Emergency Physicians Open caval index continuous positive airway pressure inferior vena cava point‐of‐care ultrasound |
| title | The effect of continuous positive airway pressure on inferior vena cava collapsibility as measured by bedside ultrasound |
| title_full | The effect of continuous positive airway pressure on inferior vena cava collapsibility as measured by bedside ultrasound |
| title_fullStr | The effect of continuous positive airway pressure on inferior vena cava collapsibility as measured by bedside ultrasound |
| title_full_unstemmed | The effect of continuous positive airway pressure on inferior vena cava collapsibility as measured by bedside ultrasound |
| title_short | The effect of continuous positive airway pressure on inferior vena cava collapsibility as measured by bedside ultrasound |
| title_sort | effect of continuous positive airway pressure on inferior vena cava collapsibility as measured by bedside ultrasound |
| topic | caval index continuous positive airway pressure inferior vena cava point‐of‐care ultrasound |
| url | https://doi.org/10.1002/emp2.12856 |
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