Ultrasonographic IVC Diameter Response to Trauma Resuscitation after One Hour Predicts 24 Hour Fluid Requirement.
Identification of occult hypovolemia in trauma patients is difficult. We hypothesized that in acute trauma patients, the response of ultrasound-measured minimum inferior vena cava diameter (IVCDMIN), IVC Collapsibility Index (IVCCI), minimum internal jugular diameter (IJVDMIN) or IJV Collapsibility Index (IJVCI) after up to 1 hour of fluid resuscitation would predict 24-hour resuscitation intravenous fluid requirements (24FR).An NTI funded, AAST-MITC prospective, cohort trial was conducted at 4 Level I Trauma Centers. Major trauma patients were screened for an IVCD ≤ 12 mm or IVCCI ≤ 50% on initial FAST. A second IVCD was obtained 40-60 minutes later, after standard-of-care fluid resuscitation. Patients whose second measured IVCD was < 10mm were deemed Non-Repleted (NON-REPLETED), those ≥10mm were Repleted (REPLETED). Prehospital and initial resuscitation fluids and 24FR were recorded. Demographics, ISS, arterial blood gasses, LOS, interventions and complications were recorded. Means were compared by ANOVA and categorical variables were compared via Chi-square. ROC curves analysis were used to compare the measures as 24FR predictors.4798 patients were screened, 196 were identified with admission IVCD of 12 mm or IVCCI of 50% or less, 144 were enrolled. There were 86 REPLETED and 58 NON-REPLETED. Demographics, initial hemodynamics or laboratory measures were not significantly different. NON-REPLETED had smaller IVCD (6.0mm ± 3.7 vs.14.2mm ± 4.3, p< 0.001) and higher IVCCI (41.7% ± 30.0 vs. 13.2% ± 12.7, p< 0.001) but no significant difference in IJVD or IJVCCI. REPLETED had greater 24FR than NON-REPLETED (2503ml ± 1751 vs. 1243ml ± 1130, p= 0.003). ROC analysis indicates IVCDMIN predicted 24FR (AUC= 0.74, C.I.: 0.64-0.84, p<0.001) as did IVCCI (AUC= 0.75, C.I.: 0.65-0.85, p<0.001) but not IJVDMIN (AUC= 0.48, C.I.: 0.24-0.60, p=0.747) or IJVCI (AUC= 0.54, C.I.: 0.42-0.67, p=0.591).Ultrasound assessed IVCDMIN and IVCCI response initial resuscitation predicts 24-hour fluid resuscitation requirements.II+ STUDY TYPE: Diagnostic tests or criteria.