Inferior Vena Cava Collapsibility Index vs Central Venous Pressure for Assessment of Intravascular Volume Status in Patients with Ischemic Heart Diseases

Abstract

Abstract Background Intravascular volume status assessment is one of the most challenging tasks for clinicians in intensive care unit so fluid therapy is considered as cornerstone in improving the outcome of the ischemic heart patients. Monitoring of intravascular volume status usually required to optimize blood flow and tissue oxygen delivery to organs to avoid any disturbance of fluid status of patient either excess fluid administration which lead to hypervolemia or insufficient fluid administration which lead to hypovolemia and Both conditions have negative effects on patient prognosis with increased risk of morbidity and mortality. Aim of the Work To assess inferior vena cava collapsibility index and central venous pressure to predict the intravascular volume status in ischemic heart patients. Patients and Methods This study was carried in intensive care unit of anesthesia department, Faculty of medicine, Ain Shams university hospitals with a duration of 6 months. Results At the first day (r = - 0.775, p value <0,001), in the 2nd day (r =-0.864, p value< 0,001) and in the 3rd day (r = -0,923, p value <0,001). The best cutoff of IVC in diagnosis of low CVP is ≥ 28.5% with area under curve 0.998, sensitivity 100%, specificity 94.7%, positive predictive value (PPV) 94.4%, negative predictive value (NPV) 100% and accuracy 97.2%. Conclusion This study is that IVC collapsibility index has a strong statically significant inverse correlation with central venous pressure which is more accurate at low central venous pressure values. Point-of-care in this study is to evaluate intravascular volume status non- invasively by using ultrasound through assessing inferior vena cava collapsibility index in ischemic heart patients. Although there is high sensitivity and specificity of ultrasonography to assess IVC collapsibility index as an indirect method of assessment of CVP.