Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio 43210, USA.
J Surg Res. 2013 Sep;184(1):561-6. doi: 10.1016/j.jss.2013.05.040. Epub 2013 Jun 3.
Traditional methods for intravascular volume status assessment are invasive and are associated significant complications. While focused bedside sonography of the inferior vena cava (IVC) has been shown to be useful in estimating intravascular volume status, it may be technically difficult and limited by patient factors such as obesity, bowel gas, or postoperative surgical dressings. The goal of this investigation is to determine the feasibility of subclavian vein (SCV) collapsibility as an adjunct to IVC collapsibility in intravascular volume status assessment.
A prospective study was conducted on a convenience sample of surgical intensive care unit patients to evaluate interchangeability of IVC collapsibility index (IVC-CI) and SCV-CI. After demographic and acuity of illness information was collected, all patients underwent serial, paired assessments of IVC-CI and SCV-CI using portable ultrasound device (M-Turbo; Sonosite, Bothell, WA). Vein collapsibility was calculated using the formula [collapsibility (%) = (max diameter - min diameter)/max diameter × 100%]. Paired measurements from each method were compared using correlation coefficient and Bland-Altman measurement bias analysis.
Thirty-four patients (mean age 56 y, 38% female) underwent a total of 94 paired SCV-CI and IVC-CI sonographic measurements. Mean acute physiology and chronic health evaluation II score was 12. Paired SCV- and IVC-CI showed acceptable correlation (R(2) = 0.61, P < 0.01) with acceptable overall measurement bias [Bland-Altman mean collapsibility difference (IVC-CI minus SCV-CI) of -3.2%]. In addition, time needed to acquire and measure venous diameters was shorter for the SCV-CI (70 s) when compared to IVC-CI (99 s, P < 0.02).
SCV collapsibility assessment appears to be a reasonable adjunct to IVC-CI in the surgical intensive care unit patient population. The correlation between the two techniques is acceptable and the overall measurement bias is low. In addition, SCV-CI measurements took less time to acquire than IVC-CI measurements, although the clinical relevance of the measured time difference is unclear.
传统的血管内容量状态评估方法具有侵入性，且会引起严重并发症。尽管下腔静脉（IVC）的重点床边超声检查已被证明可用于估计血管内容量状态，但该方法在技术上可能具有难度，并受到患者因素的限制，如肥胖、肠气或术后手术敷料。本研究的目的是确定锁骨下静脉（SCV）塌陷作为评估血管内容量状态的 IVC 塌陷的辅助手段的可行性。
对外科重症监护病房的便利样本进行了前瞻性研究，以评估 IVC 塌陷指数（IVC-CI）和 SCV-CI 的可互换性。收集完人口统计学和疾病严重程度信息后，所有患者均使用便携式超声设备（M-Turbo；Sonosite，Bothell，WA）连续、配对地评估 IVC-CI 和 SCV-CI。使用公式[塌陷率（%）=（最大直径-最小直径）/最大直径×100%]计算静脉塌陷率。使用相关系数和 Bland-Altman 测量偏差分析比较两种方法的配对测量值。
34 名患者（平均年龄 56 岁，38%为女性）总共进行了 94 次 SCV-CI 和 IVC-CI 超声测量。急性生理学和慢性健康评估 II 评分平均为 12 分。配对的 SCV 和 IVC-CI 相关性良好（R²=0.61，P<0.01），总体测量偏差可接受[Bland-Altman 平均塌陷率差异（IVC-CI 减去 SCV-CI）为-3.2%]。此外，与 IVC-CI（99 秒，P<0.02）相比，SCV-CI 获得和测量静脉直径所需的时间更短（70 秒）。
SCV 塌陷评估似乎是外科重症监护病房患者群体中 IVC-CI 的合理辅助手段。两种技术之间的相关性可以接受，总体测量偏差较低。此外，尽管测量时间差的临床相关性尚不清楚，但 SCV-CI 测量的获得时间比 IVC-CI 测量的获得时间更短。
