Measurement of vena cava inferior diameter in hemorrhagic shock diagnosis

Introduction

The present study aimed to investigate the usability of the vena cava inferior (VCI) diameter as a predictor for acute blood loss and to compare it with other parameters in patients with shock.

Methods

A total of 78 patients were included in the study. These patients were divided into two groups, a control group consisting of 50 healthy individuals and a study group consisting of 28 case patients. Vital signs of both groups were taken, shock indices were calculated and the measured VCI diameters of both groups were compared. Furthermore, VCI diameters were also compared with shock indices lactate, base excess and bicarbonate, and the relationships between these parameters and mortality were investigated.

Results

Vena cava inferior expirium (VCIe)-anteroposterior diameter (AP) was 14.3 ± 3.6 mm in the study group and 29.3 ± 4.8 mm in the control group (P = 0.000), VCIe-mediolateral diameter (ML) was 8.9 ± 2.5 mm in the study group and 19.4 ± 3.6 mm in the control group (P = 0.000), vena cava inferior inspirium (VCIi)-AP was 10.9 ± 3.6 mm in the study group and 23.8 ± 5.0 mm in the control group (P = 0.000), and VCIi-ML was 7.0 ± 3.8 mm in the study group and 15.4 ± 3.2 mm in the control group (P = 0.000). The VCI diameters of the study and control groups were significantly different. No correlation was determined between all VCI diameters and the shock index, heart rate, systolic blood pressure, diastolic blood pressure, given liquid amount, hemoglobin, hematocrit, white blood cells and base excess.

Lactate (r = 55) was correlated with all VCI diameters; however, this correlation was better for VCIe-ML. The shock index was less correlated with base excess and lactate (r = 37 and 43, respectively). A significant decrease was found in diastolic blood pressure, VCIe-ML and VCIi-ML in addition to lactate, bicarbonate and base excess when dead and alive patients were compared (P < 0.05).

Conclusion

The VCI diameter can give more reliable information compared with the shock index and other parameters, especially in trauma patients, to determine acute blood loss, and it can be used as a follow-up parameter of hemorrhagic shock. A decreased VCI diameter measured on admission in patients with hemorrhagic shock might be a predictor of high mortality.