Correlations between pulmonary artery pressures and inferior vena cava collapsibility in critically ill surgical patients: An exploratory study.
BACKGROUND
As pulmonary artery catheter (PAC) use declines, search continues for reliable and readily accessible minimally invasive hemodynamic monitoring alternatives. Although the correlation between inferior vena cava collapsibility index (IVC-CI) and central venous pressures (CVP) has been described previously, little information exists regarding the relationship between IVC-CI and pulmonary artery pressures (PAPs). The goal of this study is to bridge this important knowledge gap. We hypothesized that there would be an inverse correlation between IVC-CI and PAPs.


METHODS
Apost hocanalysis of prospectively collected hemodynamic data was performed, examining correlations between IVC-CI and PAPs in a convenience sample of adult Surgical Intensive Care Unit patients. Concurrent measurements of IVC-CI and pulmonary arterial systolic (PAS), pulmonary arterial diastolic (PAD), and pulmonary arterial mean (PAM) pressures were performed. IVC-CI was calculated as ([IVCmax- IVCmin]/IVCmax) × 100%. Vena cava measurements were obtained by ultrasound-credentialed providers. For the purpose of correlative analysis, PAP measurements (PAS, PAD, and PAM) were grouped by terciles while the IVC-CI spectrum was divided into thirds (<33, 33-65, ≥66).


RESULTS
Data from 34 patients (12 women, 22 men, with median age of 59.5 years) were analyzed. Median Acute Physiologic Assessment and Chronic Health Evaluation II score was 9. A total of 76 measurement pairs were recorded, with 57% (43/76) obtained in mechanically ventilated patients. Correlations between IVC-CI and PAS (rs= -0.334), PAD (rs= -0.305), and PAM (rs= -0.329) were poor. Correlations were higher between CVP and PAS (R2= 0.61), PAD (R2= 0.68), and PAM (R2= 0.70). High IVC-CI values (≥66%) consistently correlated with measurements in the lowest PAP ranges. Across all PAP groups (PAS, PAD, and PAM), there were no differences between the mean measurement values for the lower and middle IVC-CI ranges (0%-65%). However, all three groups had significantly lower mean measurement values for the ≥66% IVC-CI group.


CONCLUSIONS
Low PAS, PAD, and PAM measurements show a reasonable correlation with high IVC-CI (≥66%). These findings are consistent with previous descriptions of the relationship between IVC-CI and CVP. Additional research in this area is warranted to better describe the hemodynamic relationship between IVC-CI and PAPs, with the goal of further reduction in the reliance on the use of PACs.
Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA.
Stanislaw P
SP
Stawicki
Department of Anesthesiology, University of Toledo College of Medicine and Life Sciences, Toledo, USA.
Thomas J
TJ
Papadimos
Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA.
David P
DP
Bahner
Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA.
David C
DC
Evans
Department of Surgery, Division of Acute Care Surgery, Johns Hopkins Medicine, Baltimore, Maryland, USA.
Christian
C
Jones
Comparison study; correlations; inferior vena cava collapsibility index; pulmonary artery catheter; pulmonary artery pressures