Subcostal versus right lateral ultrasound measurements of inferior vena cava: Measurements obtained from these two views are not equivalent in non-ICU patients.

OBJECTIVE

The objective of this study is to assess concordance between the subcostal and right lateral view for ultrasonographic inferior vena cava measurements including the end-inspiratory diameter, end-expiratory diameter and respiratory variation represented by the caval index in spontaneously breathing healthy adults.

METHODS

We recruited a convenience sample of 33 healthy adults. A phased array ultrasound probe was used to obtain inferior vena cava measurements from a subcostal view in the sagittal plane and from a right lateral view in the coronal plane with B-mode ultrasound. End-inspiratory diameter, end-expiratory diameter and caval index were obtained for each view. A two-tailed -test was performed to compare the caval indices obtained by the two views. Bland-Altman analysis was used to obtain the limits of agreement for the inferior vena cava diameter and caval index across the two views.

RESULTS

Subcostal and right lateral caval indices across all participants were significantly different according to a paired -test ( < 0.0001). The Bland-Altman analysis showed wide limits of agreement in end-inspiratory diameter (-0.97 and 0.50 cm) and in end-expiratory diameter (-0.94 and 0.90 cm). The right lateral view underestimated the inferior vena cava caval index relative to the subcostal view.

CONCLUSIONS

The subcostal and right lateral views are not equivalent in obtaining inferior vena cava measurements in spontaneously breathing healthy adults. Current cut-off values for measurement-based applications of inferior vena cava ultrasound, including fluid responsiveness using caval indices, may not be accurate when values are obtained from the right lateral view in the coronal plane of the inferior vena cava in patients.