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Distensibility Index of Inferior Vena Cava

Purpose

The Distensibility Index of Inferior Vena Cava (dIVC) it’s the amount of increase of vena cava diameter after inspiration on a mechanical ventilated patient. This increase will rise when preload is reduced and so can be used to know when a patient its volume responsive[1]. It doesn’t give CVP or the preload of the right heart, but only if it is responsive to more volume.

Measurement

  1. On a subcostal window, measure the maximum IVC diameter on inspiration (dI) and the minimum IVC diameter on expiration (dE).
  2. Calculate the dIVC using the following formula:

Conditions and caveats

  • The patient must be on volume control ventilation, with tidal volume of about 8,5ml/Kg, breathing rate of 15 and PEEP of 4 mmHg[1].
  • There shouldn’t be abdominal hypertension[1], cardiac arrhythmias or cardiopulmonary disease[2], pending more studies
  • It must be possible to do a echocardiogram by subcostal approach, so it can’t be used on the very obese or after an laparotomy
  • The first study[1] was done on a reduced number of patient. The followup studies were only done on patients with subarachnoid hemorrhage[3] and on renal replacement therapy[4]

Reference Values

dIVC[1]
Fluid responsive >18%

Bibliography

  1. Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients; Barbier C, Loubières Y, Schmit C, et al; Intensive Care Med; 2004;30(9):1740–6  ↩

  2. Evaluation of fluid responsiveness in ventilated septic patients: back to venous return;Vignon P.;Intensive Care Med 2004;30(9):1699–701  ↩

  3. Inferior Vena Cava Distensibility as a Predictor of Fluid Responsiveness in Patients with Subarachnoid Hemorrhage; Moretti R, Pizzi B; Neurocritical Care; 13(1):3–9  ↩

  4. Inferior vena cava collapsibility to guide fluid removal in slow continuous ultrafiltration: a pilot study; Guiotto G, Masarone M, Paladino F, et al.; Intensive Care Med;2010;36(4):692–6  ↩