Baseline Diameter of the Inferior Vena Cava Measured with Sonography in Euvolemic Children and its Relationship to Somatic Variables

Abstract

Purpose To determine normative data for the inferior vena cava (VCI) diameter in euvolemic children and its correlation with different somatic parameters in a pediatric population at one center in Europe.

Materials and Methods This prospective observational study enrolled healthy children aged 4 weeks to 18y that visited our outpatient clinic. Weight, height, body surface area, and age were recorded. The children were grouped according to weight, as follows (80 children/group): < 10 kg, 10–19.9 kg, 20–29.9 kg, 30–59.9 kg, and 60–90 kg. Children were placed in a supine position and, during quiet respiration, the maximum and minimum VCI diameters were measured with M-mode ultrasonography. The collapsibility index (CI) was also automatically calculated for each subject: CI = [VCI maximum (expiratory) diameter – VCI minimum (inspiratory) diameter]/VCI maximum (expiratory) diameter.

Results From May 2016 through November 2018 we retrieved data for 415 children that underwent VCI diameter evaluations. 400 children were included (mean age: 7.8y ± 5.8, mean weight: 32 kg ± 24.4, 46 % girls). The VCI_max and the VCI_min were significantly correlated with age (r = 0.867, p < 0.001, r = 0.797, p < 0.001), height (r = 0.840, p < 0.001, r = 0.772, p < 0.001), weight (r = 0.858, p < 0.001, r = 0.809, p < 0.001), and BSA (r = 0.878, p < 0.001, r = 0.817, p < 0.001). Correlations between the CI and age, weight, height, and BSA were not statistically significant.

Conclusion This prospective study provided reference values for sonographic measurements of VCI diameters in euvolemic children and might greatly assist in assessing fluid status in sick children.

Zusammenfassung

Ziel Bestimmung normativer Daten für den Durchmesser der Vena cava inferior (VCI) bei euvolämischen Kindern und deren Korrelation mit verschiedenen somatischen Parametern in einer pädiatrischen Population an einem europäischen Zentrum.

Materialien und Methoden An dieser prospektiven Beobachtungsstudie nahmen gesunde Kinder im Alter von 4 Wochen bis 18 Jahren teil, die unsere Ambulanz besuchten. Gewicht, Größe, Körperoberfläche und Alter wurden erfasst. Die Kinder wurden nach Gewicht wie folgt gruppiert (80 Kinder/Gruppe): < 10 kg, 10–19,9 kg, 20–29,9 kg, 30–59,9 kg und 60–90 kg. Die Kinder wurden in Rückenlage gebracht, und während der ruhigen Atmung wurden der maximale und minimale VCI-Durchmesser mit M-Mode-Sonografie gemessen. Der „Collapsibility-Index“ (CI) wurde ebenfalls automatisch für jeden Probanden berechnet: CI = [maximaler (exspiratorischer) VCI-Durchmesser – minimaler (inspiratorischer) VCI-Durchmesser]/maximaler (exspiratorischer) VCI-Durchmesser.

Ergebnisse Von Mai 2016 bis November 2018 haben wir Daten für 415 Kinder erhoben, bei denen der VCI-Durchmesser ausgewertet wurde. 400 Kinder waren eingeschlossen (mittleres Alter: 7,8 Jahre ± 5,8; mittleres Gewicht: 32 kg ± 24,4; 46 % Mädchen). Der VCI_max und der VCI_min korrelierten signifikant mit dem Alter (VCI_max r = 0,867, p < 0,001; VCI_min r = 0,797, p < 0,001), der Körpergröße (VCI_max r = 0,840, p < 0,001; VCI_min r = 0,772, p < 0,001) und dem Gewicht (VCI_max r = 0,858, p < 0,001; VCI_min r = 0,809, p < 0,001) und dem BSA (VCI_max r = 0,878, p < 0,001; VCI_min r = 0,817, p < 0,001). Korrelationen von CI mit dem Alter, Gewicht, Körpergröße und BSA waren statistisch nicht signifikant.

Schlussfolgerung Diese prospektive Studie lieferte Referenzwerte für sonografische Messungen des VCI-Durchmessers bei euvolämischen Kindern und könnte bei der Beurteilung des Flüssigkeitsstatus bei kranken Kindern sehr hilfreich sein.

Key words

ultrasound - inferior vena cava - children - fluid status

Publikationsverlauf

Eingereicht: 29. August 2019

Angenommen: 26. Juli 2020

Artikel online veröffentlicht:
21. August 2020

• References

• 1 Yanagawa Y, Sakamoto T, Okada Y. Hypovolemic shock evaluated by sonographic measurement of the inferior vena cava during resuscitation in trauma patients. J Trauma 2007; 63: 1245-1248
• 2 Natori H, Tamaki S, Kira S. Ultrasonographic evaluation of ventilatory effect on inferior vena caval configuration. Am Rev Respir Dis 1979; 120: 421-427
• 3 Cheriex EC, Leunissen KM, Janssen JH. et al. Echography of the inferior vena cava is a simple and reliable tool for estimation of 'dry weight'in haemodialysis patients. Nephrol Dial Transplant 1989; 4: 563-568
• 4 Ilyas A, Ishtiaq W, Assad S. et al. Correlation of IVC Diameter and Collapsibility Index With Central Venous Pressure in the Assessment of Intravascular Volume in Critically Ill Patients. Cureus 2017; 9: e1025
• 5 Masugata H, Senda S, Okuyama H. et al. Age-related decrease in inferior vena cava diameter measured with echocardiography. Tohoku J Exp Med 2010; 222: 141-147
• 6 Haines EJ, Chiricolo GC, Aralica K. et al. Derivation of a pediatric growth curve for inferior vena caval diameter in healthy pediatric patients: brief report of initial curve development. Crit Ultrasound J 2012; 4: 12
• 7 Kathuria N, Ng L, Saul T. et al. The baseline diameter of the inferior vena cava measured by sonography increases with age in normovolemic children. J Ultrasound Med 2015; 34: 1091-1096
• 8 Ayvazyan S, Dickman E, Likourezos A. et al. Ultrasound of the inferior vena cava can assess volume status in pediatric patients. J Emerg Med 2009; 37: 219
• 9 Kutty S, Li L, Hasan R. et al. Systemic venous diameters, collapsibility indices, and right atrial measurements in normal pediatric subjects. J Am Soc Echocardiogr 2014; 27: 155-162
• 10 Taneja K, Kumar V, Anand R. et al. Normative Data for VCI Diameter and its Correlation with the Somatic Parameters in Healthy Indian Children. Indian J Pediatr 2018; 85: 108-112
• 11 Ginghina C, Beladan CC, Iancu M. et al. Respiratory maneuvers in echocardiography: a review of clinical applications. Cardiovasc Ultrasound 2009; 7: 42
• 12 Kieliszczyk J, Baranowski W, Kosiak W. Usefulness of ultrasound examination in the evaluation of a neonate's body fluid status. J Ultrason 2016; 16: 125-134
• 13 Chen L, Kim Y, Santucci KA. Use of ultrasound measurement of the inferior vena cava diameter as an objective tool in the assessment of children with clinical dehydration. Acad Emerg Med 2007; 14: 841-845
• 14 Levine AC, Shah SP, Umulisa I. et al. Ultrasound assessment of severe dehydration in children with diarrhea and vomiting. Acad Emerg Med 2010; 17: 1035-1041
• 15 Kimura BJ, Dalugdugan R, Gilcrease GW. et al. The effect of breathing manner on inferior vena caval diameter. Eur J Echocardiogr 2011; 12: 120-123