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The effect of breathing manner on inferior vena caval diameter.
MedLine Citation:
PMID:  20980326     Owner:  NLM     Status:  In-Data-Review    
AIMS: Although the inspiratory 'collapse' of the inferior vena cava (IVC) has been used to signify normal central venous pressure, the effect of the manner of  breathing  IVC size is incompletely understood. As intra-abdominal pressure rises during descent of the diaphragm, we hypothesized that inspiration through diaphragmatic excursion may have a compressive effect on the IVC.
METHODS AND RESULTS: We measured minimal and maximal intrahepatic IVC diameter on echocardiography and popliteal venous return by spectral Doppler during isovolemic inspiratory efforts in 19 healthy non-obese volunteers who were instructed to inhale using either diaphragmatic or chest wall expansion. During inspiration, the maximal diaphragmatic excursion and popliteal vein flow were compared between breathing methods. The IVC 'collapsibility index,' IVCCI, was calculated as (IVC(max)-IVC(min))/IVC(max). The difference in diaphragmatic excursion between diaphragmatic and chest wall breaths in each subject was correlated with the corresponding change in IVCCI. Diaphragmatic breathing resulted in more diaphragmatic excursion than chest wall breathing (median 3.4 cm, range 1.7-5.8 vs. 2.2 cm, range 1.0-5.2, P= 0.0003), and was universally associated with decreased popliteal venous return (19/19 vs. 9/19 subjects, P< 0.004). The difference in diaphragmatic excursion correlated with the difference in IVCCI (Spearman's rho = 0.53, P= 0.024).
CONCLUSION: During inspiration of equivalent tidal volumes, the reduction in IVC diameter and lower extremity venous return was related to diaphragmatic excursion, suggesting that the IVC may be compressed through descent of the diaphragm.
Bruce J Kimura; Randy Dalugdugan; Glynn W Gilcrease; James N Phan; Brian K Showalter; Tanya Wolfson
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Publication Detail:
Type:  Journal Article     Date:  2010-10-27
Journal Detail:
Title:  European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology     Volume:  12     ISSN:  1532-2114     ISO Abbreviation:  Eur J Echocardiogr     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-02-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100890618     Medline TA:  Eur J Echocardiogr     Country:  England    
Other Details:
Languages:  eng     Pagination:  120-3     Citation Subset:  IM    
Department of Cardiology, Scripps Mercy Hospital, University of California, 4060 Fourth Ave #206, San Diego, CA 92103, USA.
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