Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Horizon Health Network, Saint John, NB, Canada.
Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.
CJEM. 2023 Nov;25(11):902-908. doi: 10.1007/s43678-023-00584-1. Epub 2023 Sep 27.
Accurately determining the fluid status of a patient during resuscitation in the emergency department (ED) helps guide appropriate fluid administration in the setting of undifferentiated hypotension. Our goal was to determine the diagnostic utility of point-of-care ultrasound (PoCUS) for inferior vena cava (IVC) size and collapsibility in predicting a volume overload fluid status in spontaneously breathing hypotensive ED patients.
This was a post hoc secondary analysis of the SHOC-ED data, a prospective randomized controlled trial investigating PoCUS in patients with undifferentiated hypotension. We prospectively collected data on IVC size and collapsibility for 138 patients in the PoCUS group using a standard data collection form, and independently assigned a fluid status (volume overloaded, normal, volume deplete) from a composite clinical chart review blinded to PoCUS findings. The primary outcome was the diagnostic performance of IVC characteristics on PoCUS in the detection of a volume overloaded fluid status.
One hundred twenty-nine patients had completed determinant IVC assessment by PoCUS, with one hundred twenty-five receiving successful final fluid status determination, of which one hundred and seven were classified as volume deplete, thirteen normal, and seven volume overloaded. A receiver operating characteristic (ROC) curve was plotted using several IVC size and collapsibility categories. The best overall performance utilized the combined parameters of a dilated IVC (> 2.5 cm) with minimal collapsibility (less than 50%) which had a sensitivity of 85.7% and specificity of 86.4% with an area under the curve (AOC) of 0.92 for predicting an volume overloaded fluid status.
IVC PoCUS is feasible in spontaneously breathing hypotensive adult ED patients, and demonstrates potential value as a predictor of a volume overloaded fluid status in patients with undifferentiated hypotension. IVC size may be the preferred measure.
在急诊科（ED）复苏过程中准确判断患者的液体状态有助于指导对未分化低血压患者进行适当的液体管理。我们的目标是确定即时超声心动图（PoCUS）对下腔静脉（IVC）大小和塌陷度的诊断效用，以预测自主呼吸低血压 ED 患者的容量超负荷液体状态。
这是 SHOC-ED 数据的事后二次分析，是一项对未分化低血压患者进行 PoCUS 调查的前瞻性随机对照试验。我们前瞻性地使用标准数据收集表为 PoCUS 组的 138 名患者收集 IVC 大小和塌陷度的数据，并从复合临床图表审查中独立分配液体状态（容量超负荷、正常、容量不足），该审查对 PoCUS 结果进行盲法评估。主要结局是 PoCUS 上 IVC 特征对检测容量超负荷液体状态的诊断性能。
129 名患者完成了 PoCUS 有决定意义的 IVC 评估，其中 125 名患者成功完成了最终的液体状态确定，其中 107 名患者被归类为容量不足，13 名患者为正常，7 名患者为容量超负荷。使用几个 IVC 大小和塌陷度类别绘制了受试者工作特征（ROC）曲线。使用最大扩张 IVC（>2.5cm）与最小塌陷度（小于 50%）的组合参数获得了最佳的整体性能，该参数的敏感性为 85.7%，特异性为 86.4%，曲线下面积（AOC）为 0.92，用于预测容量超负荷液体状态。
PoCUS 可用于自主呼吸低血压的成年 ED 患者，并且显示出作为未分化低血压患者容量超负荷液体状态预测指标的潜在价值。IVC 大小可能是首选的测量指标。
