title: Correlation Between Transhepatic and Subcostal Inferior Vena Cava Views to Assess Inferior Vena Cava Variation: A Pilot Study.
abstract: OBJECTIVE
  To assess the feasibility and reliability of transthoracic echocardiography to measure inferior vena cava (IVC) diameter variation using a transhepatic view.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Single-center hospital.
  
  
  METHODS
  Forty consecutive patients undergoing elective cardiac surgery.
  
  
  METHODS
  Bedside transthoracic echocardiography.
  
  
  RESULTS
  Correlation between the two views was measured using Pearson R, while agreement was measured using the intraclass correlation coefficient (ICC). In a nested sub-study of 16 randomly selected participants, all images were re-rated by the same rater, who was blinded to the original measurement results, and by a second blinded operator. Correlation between the subcostal and transhepatic views was moderate when assessing maximum (R 0.46; 95% confidence interval [CI], 0.18-0.68), and minimum (R 0.55; CI, 0.29-0.74) IVC diameter. Correlation when measuring IVC diameter variation was higher (R 0.70; CI, 0.49-0.83). Agreement between the two views for IVC diameter variation measurement was substantial (ICC 0.73; CI, 0.49-0.85). Intra-rater reliability was excellent (ICC 0.95-0.99).
  
  
  CONCLUSIONS
  Agreement between subcostal and transhepatic views was substantial for the assessment of IVC diameter variation; however, the magnitude of agreement was less than anticipated. Further research is needed to determine if the transhepatic view can be used reliably in the assessment of fluid responsiveness.
authors.affiliation: Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada.
authors.forename: Jacobo Moreno
authors.initials: JM
authors.lastname: Garijo
authors.affiliation: Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada.
authors.forename: Duminda N
authors.initials: DN
authors.lastname: Wijeysundera
authors.affiliation: Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada.
authors.forename: Jo Carroll
authors.initials: JC
authors.lastname: Munro
authors.affiliation: Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada. Electronic address: Massimiliano.Meineri@uhn.ca.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Meineri
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000592:standards; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods* / Q000592:standards; D005260:Female; D006503:Hepatic Veins / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D011897:Random Allocation; D016037:Single-Blind Method; D018615:Ultrasonography, Doppler, Color / Q000379:methods* / Q000592:standards; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*
keywords: cardiac surgery; echocardiography; postoperative care; resuscitation; vena cava; volume