Table 2.
Conditions biasing inferior vena cava ultrasound findings.
| IVC CI | IVCmax | Comments | |
|---|---|---|---|
| Underestimate intravascular volume | |||
| Increased tidal volume (ventilated) | Increased? | No change? | |
| Increased inspiratory effort moving probe “in & out” of field (diaphragmatic breathing) [18] | Increased | No change | Midaxillary or midclavicular line views [23]. Cross-sectional view [18] |
| Increased inspiratory effort/deep breathing (sniff) [22, 28, 35] | Increased | No change | Large IVCmax with no collapse indicates being not hypovolemic |
| Valsalva maneuver [19] | Increased | Decreased | Large IVCmax with no collapse indicates being not hypovolemic |
| Intra-abdominal HTN [23, 36] | ? | Decreased | Large IVCmax with no collapse indicates being not hypovolemic. |
| Off-center scan (cylinder tangent effect) [37] |
Minimal changes | Decreased | Attempt to maximize IVC diameter. Cross-sectional view [18] |
| Overestimate intravascular volume | |||
| Cardiac tamponade | Decreased | Increased | Preload dependent |
| Severe valvular stenosis | Decreased | Increased | Preload dependent |
| Massive pulmonary embolism [18] | Decreased? | Increased | Preload dependent |
| Right ventricular myocardial infarction [38] | Decreased | Increased | Preload dependent, decreased venous return to LV |
| Severe tricuspid regurgitation | Decreased | Increased | |
| High PEEP [39] | Minimal change | Increased | No difference between PEEP 0 and 5 cm H20[39] |
| Decreased tidal volume | Decreased | No change? | |
| Decreased inspiratory effort/shallow breathing [22, 40] | Decreased | No change? | Highly collapsible IVC indicates being not hypervolemic |
IVC = inferior vena cava, IVC CI = IVC collapsibility index, IVCmax = IVC maximum diameter, PEEP = positive end-expiratory pressure, LV = left ventricle, and HTN = hypertension, cm H20: centimeters of water.