EBQ:Caval index: Difference between revisions

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{{JC info
{{JC info
| title= Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure.
| title= Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure.
| abbreviation=  
| abbreviation= Caval Index
| expansion=
| expansion=  
| published=  
| published= 2010
| author=Nagdev AD, Merchant RC, Tirado-Gonzalez A, Sisson CA, Murphy MC.
| author= Nagdev AD, Merchant RC, Tirado-Gonzalez A, Sisson CA, Murphy MC.
| journal= Ann Emerg Med.
| journal= Ann Emerg Med
| year= 2010
| year= 2010
| volume= 3
| volume= 55
| issue=55
| issue= 3
| pages= 290-295
| pages= 290-295
| pmid= 10.1016/j.annemergmed.2009.04.021
| pmid= 19556029
| fulltexturl= https://www.ncbi.nlm.nih.gov/pubmed/19556029
| fulltexturl= https://www.ncbi.nlm.nih.gov/pubmed/19556029
| pdfurl=http://www.annemergmed.com/article/S0196-0644(09)00482-X/pdf
| pdfurl= http://www.annemergmed.com/article/S0196-0644(09)00482-X/pdf
| status = Complete
}}
}}
==Clinical Question==
==Clinical Question==
Can emergency medicine physicians performing beside ultrasound measurement of the caval index predict a central venous pressure of less than 8 mmHg in emergency department patients?  
Can emergency medicine physicians performing bedside ultrasound measurement of the caval index predict a central venous pressure of less than 8 mmHg in emergency department patients?
 
 


==Conclusion==
==Conclusion==
*Bedside ultrasound measurement of the caval index can reliably predict a CVP of less than 8 mmHg
*A caval index (CI) >50% collapsibility with respiration strongly correlates with low CVP, suggesting intravascular volume depletion
*IVC ultrasound is a rapid, noninvasive tool for volume assessment in the ED


Bedside ultrasound to measure the caval index can be a useful tool for emergency medicine physicians to predict patients with a central venous pressure of less than 8 mmHg.
==Major Points==
 
*The caval index (CI) is calculated as: (IVC max diameter - IVC min diameter) / IVC max diameter x 100
 
*A CI >50% had a sensitivity of 91% and specificity of 94% for predicting CVP <8 mmHg
 
*IVC measurements were obtained in the subxiphoid view in the longitudinal plane, 2-3 cm from the right atrial junction
Specifically collapsibility of greater than 50% with respiration can indicate intravascular volume status.
*Emergency physicians were able to obtain adequate IVC images in 93% of patients after brief training
 
*This study provided evidence supporting the use of bedside IVC ultrasound as a surrogate for invasive CVP monitoring in the ED
 
 
==Major Points==  
 
 
==Study Design==
 
==Population==
 
 
===Patient Demographics===
===Inclusion Criteria===
 
===Exclusion Criteria===
 
 
==Interventions==
 
==Outcomes==
 
===Primary Outcome===
 
===Secondary Outcomes===
 
===Subgroup analysis===
 
==Criticisms & Further Discussion==
 
==External Links==
 
==See Also==
 
==Funding==
 
==References==
<references/>
 
[[Category:EBQ]]
 


==Study Design==
==Study Design==
*Prospective, observational study
*Single center: Rhode Island Hospital
*N = 73 ED patients with central venous catheters in place
*Study period: August 2006 - February 2008
*Primary Outcome: correlation between caval index and CVP <8 mmHg


==Population==
==Population==
===Patient Demographics===
===Patient Demographics===
*Mean age: 60 years
*Male: 52%
*Mean CVP: 9.8 mmHg
===Inclusion Criteria===
===Inclusion Criteria===
 
*ED patients with a central venous catheter already in place
*Age >17 years
*Spontaneously breathing
===Exclusion Criteria===
===Exclusion Criteria===
*Mechanically ventilated patients
*Known IVC abnormality (filter, thrombus)
*Inability to obtain adequate subxiphoid IVC view
*Known right heart failure or severe tricuspid regurgitation


 
==Interventions==
==Interventions==  
*No therapeutic intervention; this was a diagnostic accuracy study
*IVC measurements obtained by emergency medicine residents and attendings using bedside ultrasound
*IVC diameter measured in M-mode at 2-3 cm caudal to the hepatic vein-IVC junction
*CVP measured simultaneously via central venous catheter as reference standard


==Outcomes==
==Outcomes==
===Primary Outcome===
===Primary Outcome===
 
*Caval index >50% for predicting CVP <8 mmHg:
===Secondary Outcomes===  
**Sensitivity: 91%
**Specificity: 94%
 
**Positive predictive value: 87%
===Subgroup analysis===
**Negative predictive value: 96%
===Secondary Outcomes===
*Pearson correlation between CI and CVP: r = -0.74 (p<0.001)
*Inter-rater reliability for IVC measurements was high (kappa = 0.77)
*Image acquisition success rate: 93%


==Criticisms & Further Discussion==
==Criticisms & Further Discussion==
 
*Small, single-center study limits generalizability
==External Links==
*Only included spontaneously breathing patients; results do not apply to mechanically ventilated patients
*CVP itself is a poor predictor of fluid responsiveness, limiting the clinical utility of any CVP surrogate
*The 50% cutoff was derived and validated in the same cohort; external validation is needed
*Subsequent studies have questioned whether IVC collapsibility reliably predicts fluid responsiveness in septic patients
*Body habitus may limit IVC visualization in obese patients


==See Also==
==See Also==
*[[IVC ultrasound]]
*[[Volume status assessment]]
*[[Shock]]


==Funding==
==Funding==
*None reported


==References==
==References==

Latest revision as of 22:49, 21 March 2026

Complete Journal Club Article
Nagdev AD, Merchant RC, Tirado-Gonzalez A, Sisson CA, Murphy MC.. "Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure.". Ann Emerg Med. 2010. 55(3):290-295.
PubMed Full text PDF

Clinical Question

Can emergency medicine physicians performing bedside ultrasound measurement of the caval index predict a central venous pressure of less than 8 mmHg in emergency department patients?

Conclusion

  • Bedside ultrasound measurement of the caval index can reliably predict a CVP of less than 8 mmHg
  • A caval index (CI) >50% collapsibility with respiration strongly correlates with low CVP, suggesting intravascular volume depletion
  • IVC ultrasound is a rapid, noninvasive tool for volume assessment in the ED

Major Points

  • The caval index (CI) is calculated as: (IVC max diameter - IVC min diameter) / IVC max diameter x 100
  • A CI >50% had a sensitivity of 91% and specificity of 94% for predicting CVP <8 mmHg
  • IVC measurements were obtained in the subxiphoid view in the longitudinal plane, 2-3 cm from the right atrial junction
  • Emergency physicians were able to obtain adequate IVC images in 93% of patients after brief training
  • This study provided evidence supporting the use of bedside IVC ultrasound as a surrogate for invasive CVP monitoring in the ED

Study Design

  • Prospective, observational study
  • Single center: Rhode Island Hospital
  • N = 73 ED patients with central venous catheters in place
  • Study period: August 2006 - February 2008
  • Primary Outcome: correlation between caval index and CVP <8 mmHg

Population

Patient Demographics

  • Mean age: 60 years
  • Male: 52%
  • Mean CVP: 9.8 mmHg

Inclusion Criteria

  • ED patients with a central venous catheter already in place
  • Age >17 years
  • Spontaneously breathing

Exclusion Criteria

  • Mechanically ventilated patients
  • Known IVC abnormality (filter, thrombus)
  • Inability to obtain adequate subxiphoid IVC view
  • Known right heart failure or severe tricuspid regurgitation

Interventions

  • No therapeutic intervention; this was a diagnostic accuracy study
  • IVC measurements obtained by emergency medicine residents and attendings using bedside ultrasound
  • IVC diameter measured in M-mode at 2-3 cm caudal to the hepatic vein-IVC junction
  • CVP measured simultaneously via central venous catheter as reference standard

Outcomes

Primary Outcome

  • Caval index >50% for predicting CVP <8 mmHg:
    • Sensitivity: 91%
    • Specificity: 94%
    • Positive predictive value: 87%
    • Negative predictive value: 96%

Secondary Outcomes

  • Pearson correlation between CI and CVP: r = -0.74 (p<0.001)
  • Inter-rater reliability for IVC measurements was high (kappa = 0.77)
  • Image acquisition success rate: 93%

Criticisms & Further Discussion

  • Small, single-center study limits generalizability
  • Only included spontaneously breathing patients; results do not apply to mechanically ventilated patients
  • CVP itself is a poor predictor of fluid responsiveness, limiting the clinical utility of any CVP surrogate
  • The 50% cutoff was derived and validated in the same cohort; external validation is needed
  • Subsequent studies have questioned whether IVC collapsibility reliably predicts fluid responsiveness in septic patients
  • Body habitus may limit IVC visualization in obese patients

See Also

Funding

  • None reported

References

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