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Published on: January 13, 2023
Estimation of Central Venous Pressure Using Cardiac Ultrasound of Inferior Vena Cava in Ventilated Children: A
Perrine Sée1, Aurélie Hayotte1, Enora Le Roux2
1Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Université Paris-Cité, Hôpital Robert Debré, Paris, France.
Insights
Ultrasound measurements of the inferior vena cava (IVC) do not correlate with central venous pressure (CVP) in pediatric patients under mechanical ventilation (MV). This finding suggests IVC ultrasound is not a reliable tool for estimating CVP in this population.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiovascular Physiology
- Point-of-Care Ultrasound
Background:
- Central venous pressure (CVP) is a key hemodynamic parameter in managing critically ill children.
- Inferior vena cava (IVC) ultrasound is explored as a non-invasive alternative for CVP estimation, particularly in mechanically ventilated patients.
- Previous studies in adults and conflicting pediatric data highlight the need for further investigation.
Purpose of the Study:
- To investigate the correlation between central venous pressure (CVP) and ultrasound-derived inferior vena cava (IVC) parameters in pediatric patients.
- To determine if IVC collapsibility, distensibility, or diameter ratios can reliably estimate CVP in children undergoing mechanical ventilation (MV).
Main Methods:
- Prospective, multicenter observational study involving 120 children (2 days to 12 years) in French PICUs.
- Children were on mechanical ventilation (MV) with a central venous catheter for CVP monitoring.
- Ultrasound measurements of IVC diameter (maximum and minimum) were used to calculate collapsibility, distensibility, and IVC/Aortic ratios.
Main Results:
- No significant correlation was found between CVP and IVC-collapsibility (Spearman ρ = -0.09; p = 0.32).
- No significant correlation was found between CVP and IVC/Aortic ratio (Spearman ρ = 0.17; p = 0.06).
- No significant correlation was found between CVP and IVC-distensibility (Spearman ρ = -0.09; p = 0.29).
Conclusions:
- Ultrasound-derived IVC parameters do not correlate with central venous pressure (CVP) in pediatric patients under mechanical ventilation (MV).
- These findings indicate that IVC ultrasound measurements are not a reliable method for estimating CVP in this specific patient group.
- Further research may be needed to explore alternative non-invasive hemodynamic monitoring techniques in pediatric critical care.
Objectives:
Despite its numerous limitations, especially in predicting fluid responsiveness, trends in central venous pressure (CVP) values may be useful for managing certain critically ill pediatric patients. Although ultrasound parameters of the inferior vena cava (IVC) cannot be used to estimate CVP in adults under mechanical ventilation (MV), the pediatric literature reports highly contradictory results.
Design:
Prospective, multicenter observational study.
Setting:
Six PICUs in France.
Patients:
Children 2 days to 12 years old undergoing MV and had a central venous catheter in the superior vena cava to monitor CVP, from November 1, 2021, to June 30, 2023.
Interventions:
None.
Measurements And Main Results:
Ultrasound measurements (i.e., IVC maximum diameter [IVCdmax], IVC minimum diameter [IVCdmin]) were performed by experienced intensivists in order to calculate the following parameters: 1) IVC-Collapsibility: ([IVCdmax-IVCdmin]/IVCdmax) × 100; 2) IVC-Distensibility: ([IVCdmax-IVCdmin]/IVCdmin) × 100; and 3) IVC/Aortic: (IVCdmax/Ao) × 100. The search for correlation was studied using Spearman correlation tests because of monotonic relationships. We included 120 children with a median (interquartile range] age of 11.5 months (2.0-46.3 mo) and a median weight of 9.0 kg (5.0-15.0 kg). A third of the patients were admitted for postoperative care, including cardiac surgery, and a quarter for respiratory failure, with a median CVP of 7.5 mm Hg (5.0-10.3 mm Hg). No significant relationship was found between CVP and IVC-Collapsibility (Spearman ρ = -0.09; p = 0.32), IVC/Ao (Spearman ρ = 0.17; p = 0.06), or IVC-Distensibility (Spearman ρ = -0.09; p = 0.29).
Conclusions:
There is no correlation between CVP and IVC-ultrasound parameters in children under MV.
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