Ferrada Paula, Anand Rahul J, Whelan James, Aboutanos Michel A, Duane Therese, Malhotra Ajai, Ivatury Rao
Virginia Commonwealth University, Richmond, Virginia, USA.
Am Surg. 2012 Apr;78(4):468-70.
Inferior vena cava (IVC) diameter change on limited transthoracic echocardiogram (LTTE) can provide a useful guide of fluid status evaluation in critically ill patients. Institutional review board approval was obtained. Prospective evaluation of hemodynamic status was performed in hypotensive patients via LTTE. Images were obtained using an ultrasound machine without M-mode capability. Qualitative assessment of the IVC was obtained via subxyphoid window. FLAT IVC was defined as diameter less than 2 cm and FAT IVC when the vein was equal or larger than 2 cm. Collapsibility was assessed by observing respiratory variation of the vessel. Lactate was measured before and after therapy was initiated. A follow-up LTTE was obtained after fluid challenge. A total of 108 LTTE were performed. Patients' age ranged from 18 to 89 years with an average of 53. Admission diagnosis was blunt trauma in 66 patients, penetrating trauma in 17, whereas 25 had nontraumatic intra-abdominal emergency. Sixty-nine patients were receiving mechanical ventilation at time of LTTE. Seventy-three patients had a FLAT IVC, and received fluid challenge as therapy. All patients had a change in IVC volume from "FLAT" to "FAT" after the fluid challenge. Seventy-one patients (97%) had resolution of hypotension after the first fluid challenge. Two patients had persistent hypotension and received a second fluid challenge. Follow-up LTTE demonstrated a FAT IVC and lack of collapsibility. Lactate decreased in all 73 patients after therapy guided by LTTE (P < 0.00001) Evaluation of the IVC diameter via LTTE offers a rapid, non invasive way to evaluate fluid status in critically ill patients.
有限经胸超声心动图（LTTE）检查下的下腔静脉（IVC）直径变化可为危重症患者的液体状态评估提供有用指导。本研究获得了机构审查委员会的批准。通过LTTE对低血压患者的血流动力学状态进行前瞻性评估。使用无M模式功能的超声仪获取图像。通过剑突下窗口对IVC进行定性评估。扁平IVC定义为直径小于2cm，静脉直径等于或大于2cm时为饱满IVC。通过观察血管的呼吸变化评估可塌陷性。在开始治疗前后测量乳酸水平。液体冲击后进行随访LTTE检查。共进行了108次LTTE检查。患者年龄在18至89岁之间，平均年龄为53岁。入院诊断为钝性创伤的患者有66例，穿透性创伤17例，25例为非创伤性腹部急症。69例患者在进行LTTE检查时接受机械通气。73例患者的IVC为扁平型，并接受液体冲击治疗。所有患者在液体冲击后IVC容积从“扁平”变为“饱满”。71例患者（97%）在首次液体冲击后低血压症状缓解。2例患者持续低血压，接受了第二次液体冲击。随访LTTE显示IVC饱满且无可塌陷性。在LTTE指导治疗后，所有73例患者的乳酸水平均下降（P < 0.00001）。通过LTTE评估IVC直径为评估危重症患者的液体状态提供了一种快速、无创的方法。
