Skip to main content


Does bedside sonographic measurement of the IVC diameter correlate with central venous pressure (CVP) in the assessment of intravascular volume in children?

Article metrics

  • 3426 Accesses

  • 1 Citations


Previous studies demonstrated that the collapsibility index (percent decrease in inferior vena cava (IVC) diameter with inspiration) of > 50% and an IVC/Aorta ratio of < 0.8 correlated with a low intravascular volume.


Our study sought to determine if bedside ultrasound (BUS) measurements of the IVC diameter correlate with central venous pressure (CVP) measurements as an indicator of intravascular volume status in acutely ill children.

Patients and methods

A convenience sample of children < 21 years-old who were admitted to the pediatric critical care unit and required CVP monitoring had BUS measurements of both IVC and aortic diameters with simultaneous CVP measurement. The collapsibility index (sagittal view) and IVC/Aorta ratio (transverse view) were calculated from these measurements. A CVP ≤ 8 mmHg was considered as a marker for decreased intravascular volume.


Of the 51 participants, 21 (43%) had a CVP < 8 mmHg. Eight of 51 (16%) children had a collapsibility index > 50% and 8 of 43 (18%) had an IVC/Aorta ratio of < 0.8. The sensitivity of a collapsibility index ≥ 0.5 to predict a CVP ≤ 8 mmHg was 14%, the specificity was 83%, the positive predictive value was 38% and the negative predictive value was 57%. Neither collapsibility index (r=-0.23, p = 0.11) nor IVC/Aorta (r=-0.19, p = 0.22) correlated with CVP in assessing intravascular volume in our study population.


Based on these data, the IVC and aortic measurements by BUS are not reliable indicators of intravascular volume (as determined by CVP) in acutely ill children.


  1. 1.

    Brierley J, Carcillo JA, Choong K, et al.: Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Critical Care Medicine 2009,37(2):666–688. 10.1097/CCM.0b013e31819323c6

  2. 2.

    Gorelick MH, Shaw KN, Murphy KO: Validity and reliability of clinical signs in the diagnosis of dehydration in children. Pediatrics 1997,99(5):E6. 10.1542/peds.99.5.e6

  3. 3.

    Steiner MJ, DeWalt DA, Byerley JS: Is this child dehydrated? JAMA 2004, 291: 2746–54. 10.1001/jama.291.22.2746

  4. 4.

    Rothrock G, Green M, McArthur CL, DelDuca Kevin: Detection of Electrolyte Abnormalities in Children Presenting to the Emergency Department: A Multicenter, Prospective Analysis. Academic Emergency Medicine 1997, 4: 1025–1031. 10.1111/j.1553-2712.1997.tb03674.x

  5. 5.

    Vega RM, Avner JR: A Prospective study of the usefulness of clinical and laboratory parameters for predicting percentage of dehydration in children. Pediatric Emergency Care 1997, 13: 179–182. 10.1097/00006565-199706000-00001

  6. 6.

    Narchi Hassib: Serum Bicarbonate and Dehydration Severity in Gastroenteritis. Archives of Disease in Childhood 1998, 78: 70–71. 10.1136/adc.78.1.70

  7. 7.

    Teach SJ, Yates EW, Feld LG: Laboratory Predictors of Fluid Deficit in Acutely Dehydrated Children. Clinical Pediatrics 1997, 36: 395–400. 10.1177/000992289703600703

  8. 8.

    Ooi Beng Suat, et al.: Assessment of Dehydration in Adults Using Hematologic and Biochemical Tests. Academic Emergency Medicine 1997,4(8):840–844. 10.1111/j.1553-2712.1997.tb03804.x

  9. 9.

    Yen K, Gorelick MH: Ultrasound applications for the pediatric emergency department: a review of the current literature. Pediatric Emergency Care 2002, 18: 226–34. 10.1097/00006565-200206000-00020

  10. 10.

    Chen L, Baker MD: Novel applications of ultrasound in pediatric emergency medicine. Pediatric Emergency Care 2007, 23: 115–23. 10.1097/PEC.0b013e3180302c59

  11. 11.

    Lyon M, Blaivas M, Brannam L: Sonographic measurement of the inferior vena cava as a marker of blood loss. The American Journal of Emergency Medicine 2005, 23: 45–50. 10.1016/j.ajem.2004.01.004

  12. 12.

    Krause I, Birk E, Davidovits M, et al.: Inferior vena cava diameter: a useful method for estimation of fluid status in children on haemodialysis. Nephrol Dial Transplant 2001, 16: 115–23. 10.1093/ndt/16.1.115

  13. 13.

    Pershad J, Myers S, Plouman C, et al.: Bedside limited echocardiography by the emergency physician is accurate during evaluation of the critically ill patient. Pediatrics 2004, 114: e667–71. 10.1542/peds.2004-0881

  14. 14.

    Yanagawa Y, Nishi K, Sakamoto T, Okada Y: Early diagnosis of hypovolemic shock by sonographic measurement of inferior vena cava in trauma patients. Journal of Trauma 2005, 58: 825–9. 10.1097/01.TA.0000145085.42116.A7

  15. 15.

    Levine AC, et al.: Ultrasound assessment of severe dehydration in children with diarrhea and vomiting. Society for Academic Emergency Medicine 2010, 17: 1035–1041. 10.1111/j.1553-2712.2010.00830.x

  16. 16.

    Kircher BJ, Himelman RB, Schiller NB: Noninvasive Estimation of Right Atrial Pressure from the Inspiratory Collapse of the Inferior Vena Cava. The American Journal of Cardiology 1990, 66: 493–96. 10.1016/0002-9149(90)90711-9

  17. 17.

    Chen L, Hsiao A, Langhan M, Riera A, Santucci K: Use of bedside ultrasound to assess degree of dehydration in children with gastroenteritis. Society for Academic Emergency Medicine 2010, 17: 1042–1047. 10.1111/j.1553-2712.2010.00873.x

  18. 18.

    Nagdev AD, Merchant RC, Tirado-Gonzalez , Sisson CA, Murphy MC: Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure. Annals of Emergency Medicine 2010,55(3):290–5. 10.1016/j.annemergmed.2009.04.021

  19. 19.

    Stawicki SP, Braslow BM, Panebianco NL, et al.: Intensivist Use of Hand-Carried Ultrasonography to Measure IVC Collapsibility in Estimating Intravascular Volume Status: Correlations with CVP. Journal for the American College of Surgeons 2009, 209: 55–61. 10.1016/j.jamcollsurg.2009.02.062

  20. 20.

    DeLorenzo RA, Morris MJ, Williams JB, et al.: Does a simple bedside sonographic measurement of the inferior vena cava correlate to central venous pressure? The Journal of Emergency Medicine 2011,42(4):429–436.

  21. 21.

    Bendjelid K, Romand JA, Walder B, et al.: Correlation between measured inferior vena cava diameter and right atrial pressure depends on the echocardiographic method used in patients who are mechanically ventilated. J Am Soc Echocardiogr 2002, 15: 944–949. 10.1067/mje.2002.120701

  22. 22.

    Hruda J, Rothuis EG, van Elburg RM, et al.: Echocardiographic assessment of preload conditions does not help at the neonatal intensive care unit. American Journal of Perinatology 2003, 20: 297–303.

  23. 23.

    Krause I, Birk E, Davidovits M, et al.: Inferior vena cava diameter: a useful method for estimation of fluid status in children on haemodialysis. Nephrol Dial Transplant 2001, 16: 115–23. 10.1093/ndt/16.1.115

  24. 24.

    Kosiak W, Swieton D, Piskuknowicz M: Sonographic inferior vena cava/aorta diameter index, a new approach to the body fluid status assessment in children and young adults in emergency ultrasound – preliminary study. The American Journal of Emergency Medicine 2008, 26: 320–325. 10.1016/j.ajem.2007.07.012

  25. 25.

    Weekes AJ, Tassone HM, Bacock A, et al.: Comparison of Serial Qualitative and Quantitative Assessments of Caval Index and Left Ventricular Systolic Function During Early Fluid Resuscitation of Hypotensive Emergency Department Patients. Acad Emer Med 2011, 18: 912–921. 10.1111/j.1553-2712.2011.01157.x

Download references

Author information

Correspondence to Lorraine Ng.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Reprints and Permissions

About this article


  • Inferior Vena Cava
  • Inferior Vena
  • Central Venous Pressure
  • Intravascular Volume
  • Critical Care Unit