| Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure. | |
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MedLine Citation:
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PMID: 19556029 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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STUDY OBJECTIVE: Among adult emergency department (ED) patients undergoing central venous catheterization, we determine whether a greater than or equal to 50% decrease in inferior vena cava diameter is associated with a central venous pressure of less than 8 mm Hg. METHODS: Adult patients undergoing central venous catheterization were enrolled in a prospective, observational study. Inferior vena cava inspiratory and expiratory diameters were measured by 2-dimensional bedside ultrasonography. The caval index was calculated as the relative decrease in inferior vena cava diameter during 1 respiratory cycle. The correlation of central venous pressure and caval index was calculated. The sensitivity, specificity, and positive and negative predictive values of a caval index greater than or equal to 50% that was associated with a central venous pressure less than 8 mm Hg were estimated. RESULTS: Of 73 patients, the median age was 63 years and 60% were women. Mean time and fluid administered from ultrasonographic measurement to central venous pressure determination were 6.5 minutes and 45 mL, respectively. Of the 73 participants, 32% had a central venous pressure less than 8 mm Hg. The correlation between caval index and central venous pressure was -0.74 (95% confidence interval [CI] -0.82 to -0.63). The sensitivity of caval index greater than or equal to 50% to predict a central venous pressure less than 8 mm Hg was 91% (95% CI 71% to 99%), the specificity was 94% (95% CI 84% to 99%), the positive predictive value was 87% (95% CI 66% to 97%), and the negative predictive value was 96% (95% CI 86% to 99%). CONCLUSION: Bedside ultrasonographic measurement of caval index greater than or equal to 50% is strongly associated with a low central venous pressure. Bedside measurements of caval index could be a useful noninvasive tool to determine central venous pressure during the initial evaluation of the ED patient. |
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Authors:
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Arun D Nagdev; Roland C Merchant; Alfredo Tirado-Gonzalez; Craig A Sisson; Michael C Murphy |
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Publication Detail:
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Type: Journal Article Date: 2009-06-25 |
Journal Detail:
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Title: Annals of emergency medicine Volume: 55 ISSN: 1097-6760 ISO Abbreviation: Ann Emerg Med Publication Date: 2010 Mar |
Date Detail:
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Created Date: 2010-02-22 Completed Date: 2010-03-15 Revised Date: 2010-09-07 |
Medline Journal Info:
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Nlm Unique ID: 8002646 Medline TA: Ann Emerg Med Country: United States |
Other Details:
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Languages: eng Pagination: 290-5 Citation Subset: AIM; IM |
Copyright Information:
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Copyright (c) 2009 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved. |
Affiliation:
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Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Central Venous Pressure* / physiology Emergency Service, Hospital* Female Humans Hypotension / ultrasonography* Male Middle Aged Point-of-Care Systems* Predictive Value of Tests Prospective Studies Sensitivity and Specificity Vena Cava, Inferior / physiopathology, ultrasonography* |
| Comments/Corrections | |
Comment In:
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Rev Clin Esp. 2010 Sep;210(8):411 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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