title: The efficacy of sonographic measurement of inferior vena cava diameter as an estimate of central venous pressure.
abstract: BACKGROUND
  Central venous pressure (CVP) and right atrial pressure (RAP) are important parameters in the complete hemodynamic assessment of a patient. Sonographic measurement of the inferior vena cava (IVC) diameter is a non-invasive method of estimating these parameters, but there are limited data summarizing its diagnostic accuracy across multiple studies. We performed a comprehensive review of the existing literature to examine the diagnostic accuracy and clinical utility of sonographic measurement of IVC diameter as a method for assessing CVP and RAP.
  
  
  METHODS
  We performed a systematic search using PubMed of clinical studies comparing sonographic evaluation of IVC diameter and collapsibility against gold standard measurements of CVP and RAP. We included clinical studies that were performed in adults, used current imaging techniques, and were published in English.
  
  
  RESULTS
  Twenty one clinical studies were identified that compared sonographic assessment of IVC diameter with CVP and RAP and met all inclusion criteria. Despite substantial heterogeneity in measurement techniques and patient populations, most studies demonstrated moderate strength correlations between measurements of IVC diameter and collapsibility and CVP or RAP, but more favorable diagnostic accuracy using pre-specified cut points. Findings were inconsistent among mechanically ventilated patients, except in the absence of positive end-expiratory pressure.
  
  
  CONCLUSIONS
  Sonographic measurement of IVC diameter and collapsibility is a valid method of estimating CVP and RAP. Given the ease, safety, and availability of this non-invasive technique, broader adoption and application of this method in clinical settings is warranted.
authors.affiliation: David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: William
authors.initials: W
authors.lastname: Ciozda
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Group, Beverly Hills, CA, USA.
authors.forename: Ilan
authors.initials: I
authors.lastname: Kedan
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, CA, USA. Devin.Kehl@cshs.org.
authors.forename: Devin W
authors.initials: DW
authors.lastname: Kehl
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Group, Beverly Hills, CA, USA.
authors.forename: Raymond
authors.initials: R
authors.lastname: Zimmer
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Group, Beverly Hills, CA, USA.
authors.forename: Raj
authors.initials: R
authors.lastname: Khandwalla
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
authors.forename: Asher
authors.initials: A
authors.lastname: Kimchi
mesh_terms: D002496:Central Venous Pressure / Q000502:physiology*; D006801:Humans; D014463:Ultrasonography / Q000379:methods*; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*
keywords: Central venous pressure; Inferior vena cava; Right atrial pressure; Ultrasound