Hepatic vein Doppler ultrasound to estimate central venous pressure in mechanically ventilated children

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发表日期：

2024年9月26日

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Nayara Hillebrand Franzon,
Lívia da Silva Krzesinski,
Victoria Carneiro Lintz,
Isabel de Siqueira Ferraz,
Ana Paula Damiano,
Roberto José Negrão Nogueira,
Tiago Henrique De Souza

摘要

Monitoring central venous pressure (CVP) is crucial for managing critically ill patients yet poses challenges in pediatric cases. This study aimed to correlate CVP with hepatic vein Doppler and IVC ultrasound variables in children. Mechanically ventilated children underwent simultaneous ultrasound and CVP measurements. Hepatic vein Doppler assessed peak velocities (A, S, V, D) and systolic filling fraction. IVC ultrasound included respiratory variability indices, IVC/aorta ratio, and IVC/body surface area ratio. Fifty-three children were included (median age of 8.3 months and weight of 6.3 kg). Significant correlations were found between CVP values and all hepatic vein Doppler-based variables. The strongest correlation was found between CVP and the sum of the absolute values of the A- and D-wave peak velocities (AD velocity), with a ρ = 0.61 (95% confidence interval [CI] of 0.40 to 0.75; p < 0.001). The AD velocity > 38.55 cm/s was able to discriminate patients with CPV > 12 mmHg with a sensitivity of 100%, specificity of 95.3%, positive predictive value of 83.3%, and negative predictive value of 100%. No correlations were observed between CVP and variables derived from IVC respiratory variability indices or the IVC/aorta ratio.

Conclusion: Hepatic vein Doppler ultrasound provides variables that significantly correlate with CVP and may be useful for estimating cardiac preload in mechanically ventilated children. Indices derived from IVC ultrasound were not reliable for estimating CVP.

What is known?

• Increased central venous pressure (CVP) can cause interstitial edema and reduce vital organ perfusion, leading to organic dysfunctions, with encapsulated organs such as the kidneys and liver being at higher risk.

• However, measuring CVP in children poses challenges due to the difficulties and risks of central venous catheterization, frequent partial or total luminal obstructions in venous catheters, and potential technical errors in measurements.

What is new?

• Variables obtained through hepatic vein Doppler ultrasonography outperformed those obtained by inferior vena cava ultrasound for estimating CVP in this population.

• Hepatic vein Doppler ultrasonography holds potential as an accurate, safe, and non-invasive method for discriminating patients with increased cardiac preload.