Estimation of Central Venous Pressure Using Cardiac Ultrasound of Inferior Vena Cava in Ventilated Children: A Prospective Multicenter Observational Study, 2021-2023.

Abstract

Objectives: Despite its numerous limitations, especially in predicting fluid responsiveness, trends in central venous pressure (CVP) values may be useful for managing certain critically ill pediatric patients. Although ultrasound parameters of the inferior vena cava (IVC) cannot be used to estimate CVP in adults under mechanical ventilation (MV), the pediatric literature reports highly contradictory results.

Design: Prospective, multicenter observational study.

Setting: Six PICUs in France.

Patients: Children 2 days to 12 years old undergoing MV and had a central venous catheter in the superior vena cava to monitor CVP, from November 1, 2021, to June 30, 2023.

Interventions: None.

Measurements and main results: Ultrasound measurements (i.e., IVC maximum diameter [IVCdmax], IVC minimum diameter [IVCdmin]) were performed by experienced intensivists in order to calculate the following parameters: 1) IVC-Collapsibility: ([IVCdmax-IVCdmin]/IVCdmax) × 100; 2) IVC-Distensibility: ([IVCdmax-IVCdmin]/IVCdmin) × 100; and 3) IVC/Aortic: (IVCdmax/Ao) × 100. The search for correlation was studied using Spearman correlation tests because of monotonic relationships. We included 120 children with a median (interquartile range] age of 11.5 months (2.0-46.3 mo) and a median weight of 9.0 kg (5.0-15.0 kg). A third of the patients were admitted for postoperative care, including cardiac surgery, and a quarter for respiratory failure, with a median CVP of 7.5 mm Hg (5.0-10.3 mm Hg). No significant relationship was found between CVP and IVC-Collapsibility (Spearman ρ = -0.09; p = 0.32), IVC/Ao (Spearman ρ = 0.17; p = 0.06), or IVC-Distensibility (Spearman ρ = -0.09; p = 0.29).

Conclusions: There is no correlation between CVP and IVC-ultrasound parameters in children under MV.