Restricted accessResearch articleFirst published online 2011-8
My patient has no blood pressure: are they empty or full? Point-of-care ultrasound of the inferior vena cava in the hypotensive emergency department patient
Bedside, focused or point-of-care ultrasound (PoCUS) is becoming an established technique within emergency and critical care medicine to answer time-dependent, focused clinical questions. Bedside sonography is not a complete radiological investigation, rather an extension of the clinical examination to rule in or rule out key diagnoses in specific clinical settings. PoCUS is geared to addressing highly time-dependent and focused questions, and in general most focused scans become more obviously positive as the patient becomes increasingly unwell. In the hypotensive patient, one of the first questions a clinician must address is whether the patient requires emergency fluid resuscitation. That is, is the patient under-filled or overloaded? So, how can we use ultrasound to add value to our clinical assessment of filling in the hypotensive patient?
ReardonR, HeegaardB, PlummerD, Ultrasound is a necessary skill for emergency physicians. Acad Emerg Med2006;13:334–6
2.
JonesAE, YiannibasV, JohnsonC, Emergency department hypotension predicts sudden unexpected in-hospital mortality: a prospective cohort study. Chest2006;130:941–6
3.
MooreCL, RoseGA, TayalVS, Determination of left ventricular function by emergency physician echocardiography of hypotensive patients. Acad Emerg Med2002;9:186–93
4.
CarrBG, DeanAJ, EverettWW, Intensivist bedside ultrasound (INBU) for volume assessment in the intensive care unit: a pilot study. J Trauma2007;63:495–502
5.
NagdevAD, MerchantRC, Tirado-GonazalezA, Emergency department bedside ultrasonographic measurement of caval index for noninvasive determination of low central venous pressure. Ann Emerg Med2009;25:1–6
6.
StawickiSP, BraslowBM, ParebiancoNL, Intensivist use of hand-carried ultrasonography to measure IVC collapsibility in estimating intravascular volume status: correlations with CVP. J Am Coll Sug2009;209:55–61
7.
GunstM, GhaemmaghamiV, SperryJ, Accuracy of cardiac function and volume status estimates using bedside ECHO assessment in trauma/critical care. J Trauma2009;65:509–16
8.
JonesAE, TayalVS, SullivanDM, Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of non-traumatic hypotension in emergency department patients. Crit Care Med2004;32:1703–8
9.
RoseJ, BairA, MandaviaD, The UHP ultrasound protocol: a novel ultrasound approach to the empiric evaluation of the undifferentiated hypotensive patient. Am J Emerg Med2001;19:299–302
10.
AxlerO. Evaluation and management of shock. Semin Respir Crit Care Med2006;127:230–40
WallaceDJ, AllisonM, StoneMB. Inferior vena cava percentage collapse during respiration is affected by sampling location: an ultrasound study in healthy volunteers. Acad Emerg Med2010;17:96–9
13.
KircherBJ, HimelmanRB, SchillerNB. Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol1990;66:493–6
14.
BrennanJ, BlairJ, GoonewardenaS, Reappraisal of the use of inferior vena cava for estimating right atrial pressure. J Am Soc Echocardiogr2007:20:857–61
15.
AtkinsonPRT, MCAuleyDJ, KendallRJ, Abdominal and cardiac evaluation with sonography in shock (ACES): an approach by emergency physicians for the use of ultrasound in patients with undifferentiated hypotension. Emerg Med J2009;26:87–91
16.
MarikPE. Techniques for assessment of intravascular volume in critically ill patients. J Intensive Care Med2009;24:329–37
17.
SchefoldJC, StormC, BercherS, Inferior vena cava diameter correlates with invasive haemodynamic measures in mechanically ventilated ICU patient with sepsis. J Emerg Med2007;27:1–6
18.
FeisselM, MichardF, FallerJP, The respiratory variation in inferior vena cava diameter as a guide to fluid therapy. Intensive Care Med2004;30:1834–7
19.
RandazzoMR, SnoeyER, LevittMA, Accuracy of emergency physician assessment of left ventricular ejection fraction and central venous pressure using echocardiography. Acad Emerg Med2003;10:973–7
20.
MasugataH, SendaS, OkuyamaH, Age-related decrease in inferior vena cava diameter measured with echocardiography. Tohoku J Exp Med2010;222:141–7
21.
PereraP, MailhotT, RileyD, The RUSH exam: Rapid Ultrasound in Shock in the evaluation of the critically ill. Emerg Med Clin N Am2010;28:29–56
22.
DonahueSP, WoodJP, BhaveshMP, Correlation of sonographic measurements of the internal jugular vein with central venous pressure. Am J Emerg Med2009;27:851–5
