title: Agreement between inferior vena cava diameter measurements by subxiphoid versus transhepatic views.
abstract: BACKGROUND
  Correcting hypovolemia is extremely important. Central venous pressure measurement is often done to assess volume status. Measurement of inferior vena cava (IVC) is conventionally done in the subcostal view using ultrasonography. It may not be possible to obtain this view in all patients.
  
  
  OBJECTIVE
  We therefore evaluated the limits of agreement between the IVC diameter measurement and variation in subcostal and that by the lateral transhepatic view.
  
  
  METHODS
  Prospective study in a tertiary care referral hospital intensive care unit.
  
  
  METHODS
  After Institutional Ethics Committee approval and informed consent, we obtained 175 paired measurements of the IVC diameter and variation in both the views in adult mechanically ventilated patients. The measurements were carried out by experienced researchers. We then obtained the limits of agreement for minimum, maximum diameter, percentage variation of IVC in relation to respiration.
  
  
  METHODS
  Bland-Altman's limits of agreement to get precision and bias.
  
  
  RESULTS
  The limits of agreement were wide for minimum and maximum IVC diameter with variation of as much as 4 mm in both directions. However, the limits of agreement were much narrower when the percentage variation in relation to respiration was plotted on the Bland-Altman plot.
  
  
  CONCLUSIONS
  We conclude that when it is not possible to obtain the subcostal view, it is possible to use the lateral transhepatic view. However, using the percentage variation in IVC size is likely to be more reliable than the absolute diameter alone. It is possible to use both views interchangeably.
authors.affiliation: Division of Critical Care Medicine, Department of Anaesthesia Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors.forename: Atul Prabhakar
authors.initials: AP
authors.lastname: Kulkarni
authors.affiliation: Division of Critical Care Medicine, Department of Anaesthesia Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors.forename: S
authors.initials: S
authors.lastname: Janarthanan
authors.affiliation: Division of Critical Care Medicine, Department of Anaesthesia Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors.forename: M M
authors.initials: MM
authors.lastname: Harish
authors.affiliation: Division of Critical Care Medicine, Department of Anaesthesia Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors.forename: Siddique
authors.initials: S
authors.lastname: Suhail
authors.affiliation: Division of Critical Care Medicine, Department of Anaesthesia Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors.forename: Harish
authors.initials: H
authors.lastname: Chaudhari
authors.affiliation: Department of Anaesthesia Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors.forename: Vandana
authors.initials: V
authors.lastname: Agarwal
authors.affiliation: Department of Anaesthesia Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors.forename: Vijaya P
authors.initials: VP
authors.lastname: Patil
authors.affiliation: Department of Anaesthesia Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors.forename: Jigeeshu V
authors.initials: JV
authors.lastname: Divatia
keywords: Fluid responsiveness; inferior vena cava collapsibility; inferior vena cava diameter; inferior vena cava distensibility; limits of agreement
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