Inferior Vena Cava Collapsibility Index to Assess Central Venous Pressure in Perioperative Period Following Cardiac Surgery in Children


The inferior vena cava collapsibility index (IVCCI) is an ultrasound method used to assess central venous pressure (CVP). Our objective was to evaluate the correlation between IVCCI and CVP in children during the early period following surgery for congenital heart disease (CHD). Prospective study performed in a single tertiary care center. Patients  ≤ 18 years old, who underwent cardiopulmonary bypass surgery for CHD, were enrolled. Ultrasound images of the inferior vena cava (IVC) were obtained at two time points; the first was within 2 h of arrival to the CICU and the second was 12–18 h from the first measurement. CVP measured by catheter placed during surgery was recorded within minutes of performing ultrasound. Maximum and minimum IVC diameters were measured by 2D images and M mode method. Seventy patients (47.1% males), with median age 7 months (IQR 4–47 months) and weight 6.9 kg (IQR 4.8–13.5 kg), were evaluated. The 2D IVCCI had inverse correlation with CVP in patients breathing spontaneously; r =  − 0.76 (p < 0.01) and r =  − 0.73 (p < 0.01), during the first and second measurements, respectively. The 2D IVCCI ≤ 0.24 had sensitivity, specificity, and negative predictive value of 94%, 79%, and 88.9% , respectively, to detect CVP ≥ 10 mmHg. No correlation was found between IVCCI and CVP during positive pressure ventilation. There is a significant inverse correlation between 2D IVCCI and CVP in spontaneously breathing children after surgery for CHD. Use of 2D IVCCI for monitoring CVP could reduce the frequency and duration of CVP catheters and their inherent complications.

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  1. 1.

    Bronicki RA, Chang AC (2011) Management of the postoperative pediatric cardiac surgical patient. Crit Care Med 39(8):1974–1984

    Article  Google Scholar 

  2. 2.

    Ullman AJ, Marsh N, Mihala G et al (2015) Complications of Central Venous Access Devices: A Systematic Review. Pediatrics 136(5):e1331-1344

    Article  Google Scholar 

  3. 3.

    Zhao J, Wang G (2016) Inferior Vena Cava Collapsibility Index is a Valuable and Non-Invasive Index for Elevated General Heart End-Diastolic Volume Index Estimation in Septic Shock Patients. Med Sci Monit 22:3843–3848

    Article  Google Scholar 

  4. 4.

    Karacabey S, Sanri E, Guneysel O (2016) A Non-invasive Method for Assessment of Intravascular Fluid Status: Inferior Vena Cava Diameters and Collapsibility Index. Pak J Med Sci 32(4):836–840

    PubMed  PubMed Central  Google Scholar 

  5. 5.

    Sobczyk D, Nycz K, Andruszkiewicz P (2015) Bedside ultrasonographic measurement of the inferior vena cava fails to predict fluid responsiveness in the first 6 hours after cardiac surgery: a prospective case series observational study. J Cardiothorac Vasc Anesth 29(3):663–669

    Article  Google Scholar 

  6. 6.

    Mugloo MM, Malik S, Akhtar R (2017) Echocardiographic Inferior Vena Cava Measurement As An Alternative to Central Venous Pressure Measurement in Neonates. Indian J Pediatr 84(10):751–756

    Article  Google Scholar 

  7. 7.

    Finnerty NM, Panchal AR, Boulger C et al (2017) Inferior Vena Cava Measurement with Ultrasound: What Is the Best View and Best Mode? West J Emerg Med 18(3):496–501

    Article  Google Scholar 

  8. 8.

    Kutty S, Li L, Hasan R et al (2014) Systemic venous diameters, collapsibility indices, and right atrial measurements in normal pediatric subjects. J Am Soc Echocardiogr 27(2):155–162

    Article  Google Scholar 

  9. 9.

    Ng L, Khine H, Taragin BH et al (2013) Does bedside sonographic measurement of the inferior vena cava diameter correlate with central venous pressure in the assessment of intravascular volume in children? Pediatr Emerg Care 29(3):337–341

    Article  Google Scholar 

  10. 10.

    Iwamoto Y, Tamai A, Kohno K et al (2011) Usefulness of respiratory variation of inferior vena cava diameter for estimation of elevated central venous pressure in children with cardiovascular disease. Circ J 75(5):1209–1214

    Article  Google Scholar 

  11. 11.

    Haycock GB, Schwartz GJ, Wisotsky DH (1978) Geometric method for measuring body surface area: a height-weight formula validated in infants, children, and adults. J Pediatr 93(1):62–66

    CAS  Article  Google Scholar 

  12. 12.

    Kurath-Koller S, Avian A, Cantinotti M et al (2019) Normal Pediatric Values of the Subcostal Tricuspid Annular Plane Systolic Excursion (S-TAPSE) and Its Value in Pediatric Pulmonary Hypertension. Can J Cardiol 35(7):899–906

    Article  Google Scholar 

  13. 13.

    Brennan JM, Blair JE, Goonewardena S et al (2007) Reappraisal of the use of inferior vena cava for estimating right atrial pressure. J Am Soc Echocardiogr 20(7):857–861

    Article  Google Scholar 

  14. 14.

    Vaish H, Kumar V, Anand R et al (2017) The Correlation Between Inferior Vena Cava Diameter Measured by Ultrasonography and Central Venous Pressure. Indian J Pediatr 84(10):757–762

    Article  Google Scholar 

  15. 15.

    Egbe AC, Pellikka PA, Miranda WR et al (2020) Echocardiographic predictors of severe right ventricular diastolic dysfunction in tetralogy of Fallot: Relations to patient outcomes. Int J Cardiol. 306:49–55

    Article  Google Scholar 

  16. 16.

    Kircher BJ, Himelman RB, Schiller NB (1990) Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol 66(4):493–496

    CAS  Article  Google Scholar 

  17. 17.

    Kelley JR, Mack GW, Fahey JT (1995) Diminished venous vascular capacitance in patients with univentricular hearts after the Fontan operation. Am J Cardiol 76(3):158–163

    CAS  Article  Google Scholar 

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The project was financed in part by the “Ashok and Ingrid Sarnaik Endowment Junior Faculty Research grant.”


The project was financed in part by the “Ashok and Ingrid Sarnaik Endowment Junior Faculty Research Grant.”

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All authors contributed to the study conception, design, performance, statistical analysis, and writing of the study. All authors read and approved the final manuscript.

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Correspondence to Richard U. Garcia.

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The IRB at Wayne State University approved this study.

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This research study was performed at Children’s Hospital of Michigan.

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Garcia, R.U., Meert, K.L., Safa, R. et al. Inferior Vena Cava Collapsibility Index to Assess Central Venous Pressure in Perioperative Period Following Cardiac Surgery in Children. Pediatr Cardiol 42, 560–568 (2021).

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