Sonographic evaluation of vena cava inferior circumference before and after of volume replasman applied in emergency department

Background/ Objectives: In this study we aimed to determine the effect of circulatory blood volume on IVC size and shape by using ultrasonography in patients who referred to the emergency department due to hypovolemia and anemia and were administered volume replacement. Method: 100 patients with hypovolemia or hematologic diseases were included. IVC diameters were measured by bedside USG at subxiphoid region 3 cm caudal to the confluence of hepatic vein and IVC in M-mode during inspiration and expiration. Inspiratory and expiratory diameters of IVC were measured during only one respiratory cycle and obtained by measuring the distance between one inner wall of the vein and the opposite inner wall. The measurements repeated after the volume replacements. Independent Samples t test was used to compare the variables of the patients and Paired t test was used to compare the pretreatment and posttreatment variables. p<0,05 was considered statistically significant. Findings: Among 100 patients who were included in the study, 49% were male and 51% were female. The mean age of the patient group was 61.52±17.47 (19-92) years and the average weight was 69.10 ± 9.04 (50-102) kg. In the patient group, the mean SBP measured after volume replacement was 118±11.6 mmHg and there was a statistically significant difference between the mean pretreatment SBP 114±15.1 mmHg (p <0,001). After the volume replacement, the mean DBP of the patient group was 70.2±9.4 mmHg and there was a statistically significant difference between the mean pretreatment DBP 67±10.1 mmHg (p <0,008). The mean heart rates measured after fluid resuscitation in the patient group was 84.6±8.8 / min, which was statistically significantly lower than the heart rates measured before treatment (p <0.001). In the study group, the mean inspiratory anteroposterior (AP) diameter of the IVC was 13.1±4.2 mm and significantly higher than the pre-replacement AP diameter (11.5 ± 4.2 mm) (p <0.001) . In the study group, the mean anteroposterior (AP) diameter of the expiratory volume of IVC after volume replacement was measured as 17.5±3.9 mm and significantly larger than pre-replacement AP diameter (15.9±4.2 mm) (p <0.001). Calculated IVKKOI was 0,27±0,19 before volume replacement; and 0.24±0.18 after replacement, which was not statistically significant (p <0.174). Results : Ultrasonographic measurements of IVC diameters allows to rapidly and reliably diagnose the patients with early stages of hypovolemia in the Emergency Department in a non invasive way. In addition, serial measurements of IVC diameters by ultrasonography are useful for evaluating the intravenous fluid therapy in hypovolemic patients.