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首页> 外文期刊>Journal of Clinical Ultrasound: JCU >Influence of head‐of‐bed elevation on the measurement of inferior vena cava diameter and collapsibility
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Influence of head‐of‐bed elevation on the measurement of inferior vena cava diameter and collapsibility

机译：床头升高对近腔静脉直径测量的影响及折叠

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Abstract Purpose Inferior vena cava (IVC) diameter and variation are commonly measured in the supine position to estimate intravascular volume status of critically ill patients. Many scientific societies describe the measurement of IVC diameter in the supine position. However, critically ill patients are rarely placed supine due to concerns for aspiration risk, worsened respiratory mechanics, increases in intracranial pressure, and the time it takes to change patient position. We assessed the influence of head‐of‐bed (HOB) elevation on IVC measurements. Methods We conducted a prospective observational study of critically ill patients undergoing critical care ultrasound. With HOB at 0°, IVC maximum (IVCmax0°) and minimum (IVCmin0°) diameters were measured. Measurements were then repeated with HOB elevated to 30° and 45°. Collapsibility index (CI), defined as (IVCmax ? IVCmin)/IVCmax, was calculated for each HOB elevation. Mean differences were then compared. Results A convenience sample of 95 patients was studied, of whom 45% were on vasopressors and 44% were spontaneously breathing. The CI did not significantly differ between the three positions. We found a significant difference ( P ≤?.0001) between IVCmax at 45° (2.09?cm) and 0° (1.96?cm), IVCmin at 45° (1.75?cm) and 0° (1.59?cm), IVCmax at 45° (2.09?cm) and 30° (1.97?cm), and IVCmin at 45° (1.75?cm) and 30° (1.61?cm). Conclusions In a population of critically ill patients undergoing goal‐directed ultrasound examinations, elevating HOB to 30° did not significantly alter IVC measurements or CI. At 45°, however, IVCmax and IVCmin diameters increased significantly, albeit with no significant change in CI. Performing ultrasound measurements of the IVC with HOB elevated to 30° is unlikely to produce clinically meaningful changes.
机译：摘要目的下腔静脉（IVC）直径和变异通常以仰卧位测量，以估计危重病人的血管内体积状态。许多科学社会描述了仰卧位的IVC直径的测量。然而，由于呼吸力学恶化的呼吸力学，颅内压力增加，患有危重患者很少被抑制延迟。颅内压力增加，以及改变患者位置所需的时间。我们评估了床头（滚刀）高程对IVC测量的影响。方法对经受关键护理超声的危重患者进行了前瞻性观察研究。在0°，测量IVC最大（IVCMAX0°）和最小（IVCMIN0°）直径的滚刀。然后用滚刀重复测量，升高至30°和45°。可折叠指数（CI），定义为（IVCMAX？IVCMIN）/ IVCMAX，为每个滚刀升降计算。比较平均差异。结果研究了95名患者的便利性样本，其中45％在血管加压器上，44％是自发呼吸的。三个位置之间的CI没有显着差异。我们发现IVCmax在45°（2.09Ωcm）和0°（1.96Ωcm），Ivcmin处的显着差异（p≤≤0001），Ivcmin在45°（1.75Ωcm）和0°（1.59Ωcm），IVcmax在45°（2.09Ωcm）和30°（1​​.97Ωcm），45°（1.75Ωcm）和30°（1​​.61Ωcm）的IVcmin。在进行目标定向超声检查的患者患者的患者中，升高到30°的患者患者的群体没有显着改变IVC测量或CI。然而，在45°处，IVCmax和IVCmin直径显着增加，尽管CI没有显着变化。用垫圈进行IVC的超声测量，不太可能产生临床有意义的变化。

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