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Inferior Vena Cava to Aorta Ratio in Children With Non-Hemorrhagic Shock After Fluid Bolus Using Point of Care
Vengatabaskarane Hamsika1, Prerna Batra, Vikram Bhaskar
1Department of Pediatrics, University College of Medical College and GTB Hospital, Delhi, India.
Insights
Point of care ultrasound measurements of the Inferior Vena Cava (IVC) and Aorta (Ao) ratio and IVC indices showed physiological responses to fluid bolus therapy in pediatric non-hemorrhagic shock. However, weak correlations with clinical parameters limit their utility.
Area of Science:
- Pediatric Critical Care Medicine
- Emergency Medicine
- Point of Care Ultrasound
Background:
- Non-hemorrhagic shock in children requires prompt fluid resuscitation.
- Assessing fluid responsiveness is crucial for effective management.
- Point of care ultrasound (POCUS) offers a rapid bedside assessment tool.
Purpose of the Study:
- To compare the Inferior Vena Cava (IVC)/Aorta (Ao) ratio and IVC collapsibility/distensibility indices before and after fluid bolus therapy in children with non-hemorrhagic shock.
- To correlate changes in the IVC/Ao ratio with changes in heart rate, shock index, and blood pressure post-fluid administration.
Main Methods:
- A cross-sectional observational study involving children aged 1-12 years with non-hemorrhagic shock.
- POCUS was used to measure IVC diameter, IVC collapsibility/distensibility, and the IVC/Ao ratio before and after fluid bolus.
- Vital parameters including heart rate, shock index, and blood pressure were recorded.
Main Results:
- The IVC/Ao ratio significantly increased after fluid bolus (0.79 to 0.91, P<0.001).
- IVC collapsibility/distensibility indices significantly decreased post-fluid administration.
- Changes in the IVC/Ao ratio showed weak positive correlations with changes in heart rate (r=0.28) and shock index (r=0.26).
Conclusions:
- IVC/Ao ratio and IVC indices reflect physiological responses to fluid therapy in pediatric non-hemorrhagic shock.
- The weak correlation of these ultrasound parameters with other clinical indicators suggests limited clinical utility.
- Further research with larger sample sizes is warranted to validate these findings.
Objective:
To compare IVC/Ao ratio, IVC collapsibility/distensibility indices before and after the administration of fluid bolus therapy in children with non-hemorrhagic shock using point of care ultrasound, and to correlate the changes in IVC/Ao ratio after fluid bolus therapy with changes in heart rate, shock index, and blood pressure.
Methods:
Cross-sectional observational study was conducted in children aged 1 to 12 years with non-hemorrhagic shock requiring fluid bolus therapy. Vital parameters were recorded and IVC diameter, IVC collapsibility/distensibility, IVC/Aorta ratio were measured using point of care ultrasound before and after administration of fluid bolus.
Results:
IVC/Aorta ratio showed a significant increase [0.79 (0.06) vs. 0.91 (0.07); P <0.001] after fluid bolus. Also, a significant decrease was observed in IVC collapsibility /distensibility indices from 58.29 (8.28) and 49.26 (15.50) to 37.39 (8.03) and 29.51 (10.55), respectively. Change in IVC/Aorta ratio showed a weak positive correlation with change in heart rate ( r =0.28), and shock index ( r =0.26).
Conclusions:
Although IVC/Aorta ratio and IVC indices reflect physiological response to fluid therapy in children with non-hemorrhagic shock, its weak correlation with other clinical parameters limits its clinical utility. Further studies with larger sample sizes are needed to validate these findings.
