Abu-Zidan Fikri M
Fikri M Abu-Zidan, Department of Surgery, College of Medicine and Health Sciences, UAE University, PO Box 17666, Al-Ain, United Arab Emirates.
World J Crit Care Med. 2016 Feb 4;5(1):7-11. doi: 10.5492/wjccm.v5.i1.7.
Point-of-care ultrasound has been increasingly used in evaluating shocked patients including the measurement of inferior vena cava (IVC) diameter. Operators should standardize their technique in scanning IVC. Relative changes are more important than absolute numbers. We advise using the longitudinal view (B mode) to evaluate the gross collapsibility, and the M mode to measure the IVC diameter. Combining the collapsibility and diameter size will increase the value of IVC measurement. This approach has been very useful in the resuscitation of shocked patients, monitoring their fluid demands, and predicting recurrence of shock. Pitfalls in measuring IVC diameter include increased intra-thoracic pressure by mechanical ventilation or increased right atrial pressure by pulmonary embolism or heart failure. The IVC diameter is not useful in cases of increased intra-abdominal pressure (abdominal compartment syndrome) or direct pressure on the IVC. The IVC diameter should be combined with focused echocardiography and correlated with the clinical picture as a whole to be useful.
床旁超声已越来越多地用于评估休克患者,包括测量下腔静脉(IVC)直径。操作人员在扫描IVC时应规范其技术。相对变化比绝对数值更重要。我们建议使用纵切面(B模式)评估总体塌陷情况,使用M模式测量IVC直径。结合塌陷情况和直径大小将提高IVC测量的价值。这种方法在休克患者的复苏、监测其液体需求以及预测休克复发方面非常有用。测量IVC直径时的陷阱包括机械通气导致的胸内压升高,或肺栓塞或心力衰竭导致的右心房压力升高。在腹内压升高(腹腔间隔室综合征)或IVC受到直接压迫的情况下,IVC直径并无帮助。IVC直径应与重点超声心动图相结合,并与整体临床情况相关联,才会有用。