The role of bedside ultrasonography and carotid doppler PEAK FLOW rate and vena cava inferior diameter measurements in the evaluation of volume deficiency in the department of emergency

Among the patients admitted to the emergency department, multi-organ damage develops due to circulatory failure in patients with low intravascular volume status. Delay in hypovolemic shock treatment can increase mortality rate. In our study, we measured the diameter of the Vena Cava Inferior (VCI), which was previously proven to show the volume status, by bedside ultrasonography as soon as the patients presented to the emergency department .After that we measured the respiratory variation of the carotid doppler peak flow rate, which is easier and quicker to perform. By comparing these, we investigated how much information carotid doppler can provide about intravascular status. Thirty hypovolemic patients and thirty healthy volunteers for the control group were included in the study. VCI diameters were measured by bedside ultrasonography from the subxiphoidal region in inspiration and expiration phase. Respiratory variation of carotid artery peak flow rate (ΔVpeak) was measured. Ultrasonographic measurements of the patient group were repeated after 1000 cc isotonic NaCl infusion. Independent samples t test was used to compare the variables between the patient and control groups, and Paired t test was used to compare the pre- and post-treatment variables of the patient group. P value of <0,05 was considered statistically significant. Inspiratory diameter of VCI (0,24±0,23 cm) in the patient group was significantly lower than that of the control group (1,44±0,33 cm) (p<0.001). VCI expiratory diameter was significantly lower in the patient group (0,78±0,38 cm) than the control group (1,79±0,37 cm) (p<0,001). CarotidΔVpeak was significantly lower in the patient group (87,87±35,71 cm/sec) and in the control group (106,2±21,21 cm/sec) (p=0,047). In the patient group, after 1000 cc isotonic NaCl infusion, the inspiratory diameter of VCI (0.61±0,4 cm) was significantly higher than the pre-treatment value (p<0,001). In the patient group, after 1000 cc isotonic NaCl infusion, the expiratory diameter of VCI (1,16±0,51 cm) was significantly higher than the pre-treatment value (p<0,001). After 1000 cc isotonic NaCl infusion (84,82±38,35 cm/sec) in the carotid ΔVpeak patient group, there was no significant difference with the pre-treatment value (p=0,729). Bedside ultrasonographic measurements of VCI diameters and carotid doppler ΔVpeak; Provides noninvasive, rapid and reliable early diagnosis of hypovolemia in patients admitted to the emergency department. In addition, as a result of our study, serial measurements of carotid doppler ΔVpeak with bedside ultrasonography are not useful enough in the follow-up of fluid therapy in hypovolemic patients, but measurement of VCI diameters was found useful. Keywords: Hypovolemia, Bedside ultrasonography, Vena cava inferior, Respiratory variation of carotid artery peak flow rate