Sonographic Measurement of Inferior Vena Cava Diameters and Its Usefulness during Resuscitation of Patients with Trauma

ABSTRACT

Introduction: Hemorrhagic shock is the leading etiology in most cases of trauma and can be rapidly fatal. Thus adequate fluid resuscitation is required to improve the outcome of patients. CVP is usually used to guide resuscitation. Point-of-care sonography in emergency medicine provides non-invasive assessment of intravascular volume status. Measurement of inferior vena cava does not require special preparation as it can be done along with FAST examination. Materials & Methods: This observational study was conducted on patients with history of trauma presenting to Emergency Department. The patients were divided into two groups a hypotension group with hypotension on presentation and a normotensive group with normal blood pressure. The diameters of IVC both during inspiration (IVCi) and expiration (IVCe) were measured by M-mode ultrasound using a 3-5 MHz Phased Array Transducer. Results: Both IVCe and IVCi were significantly smaller in hypotension group as compared to normotension group of patients, while collapsibility index was increased in hypotensive group. The mean IVCe diameter was 7.8 mm in hypotension group. There was positive correlation of IVC parameters to blood pressure, and shock index. Post-resuscitation there was increase in diameters of IVC, decrease in collapsibility of IVC, and significant improvement in the vital parameters. Conclusion: The study showed that the measurement of IVC diameter can be used as a reliable tool to guide resuscitation in trauma patients and can help to predict significant hypovolemia, in patients having normal blood pressure