Department of Medical Intensive Care, CHU de Caen Normandie, Caen, France.
Department of Intensive Care, Center Hospitalier General Mémorial France Etats-Unis, Saint Lô, France.
Echocardiography. 2020 Aug;37(8):1171-1176. doi: 10.1111/echo.14802. Epub 2020 Aug 5.
Evaluation of the inferior vena cava (IVC) is not always possible through the subcostal (SC) window.
Inferior vena cava diameters measured by transhepatic (TH) and SC views were compared by Bland and Altman analysis.
131 patients were enrolled, including 88 (67%) under mechanical ventilation. The echogenicity was statistically poorer through the TH view in comparison with the SC view (P = .002). The correlation between the SC and TH views was good and better for respiratory variation than for end-expiratory or end-inspiratory diameter measurements (r = 0.86). Despite low bias, the limits of agreement were wide (-7.5 and 7.7 mm for end-expiratory diameter, -8.7 and 8.5 mm for end-inspiratory diameter, and -5.3 and 5.8 mm for respiratory variation). Complementary analysis showed that the concordance between the SC and the TH views was better when the IVC was distended. However, the limits of agreement remained broad.
Although feasible in almost all patients, the TH view does not provide better echogenicity in comparison with the SC view. Despite a good correlation with the SC view and a low bias, the limits of agreement were wide, especially when the IVC has an ellipsoidal shape, suggesting caution in the interpretation of data obtained by the TH view.
通过肋缘下（SC）窗并不能总是对下腔静脉（IVC）进行评估。
通过 Bland–Altman 分析比较经肝（TH）和 SC 视图测量的下腔静脉直径。
共纳入 131 例患者，其中 88 例（67%）在机械通气下。与 SC 视图相比，TH 视图的回声质量统计学上较差（P =.002）。SC 和 TH 视图之间的相关性良好，对于呼吸变异的相关性优于呼气末或吸气末直径测量（r = 0.86）。尽管偏倚较低，但一致性界限较宽（呼气末直径为-7.5 和 7.7mm，吸气末直径为-8.7 和 8.5mm，呼吸变异为-5.3 和 5.8mm）。补充分析显示，当 IVC 扩张时，SC 和 TH 视图之间的一致性更好。然而，一致性界限仍然较宽。
虽然在几乎所有患者中都可行，但与 SC 视图相比，TH 视图并不能提供更好的回声质量。尽管与 SC 视图相关性良好且偏倚较低，但一致性界限较宽，尤其是当 IVC 呈椭圆形时，这表明在解释 TH 视图获得的数据时应谨慎。
