Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr 3;11(1):15.
doi: 10.1186/s40635-023-00505-7.

Assessment of the inferior vena cava collapsibility from subcostal and trans-hepatic imaging using both M-mode or artificial intelligence: a prospective study on healthy volunteers

Filippo Sanfilippo  1   2 , Luigi La Via  3   4 , Veronica Dezio  3   4 , Cristina Santonocito  3 , Paolo Amelio  3   4 , Giulio Genoese  5 , Marinella Astuto  3   4 , Alberto Noto  6
Affiliations

Assessment of the inferior vena cava collapsibility from subcostal and trans-hepatic imaging using both M-mode or artificial intelligence: a prospective study on healthy volunteers

Filippo Sanfilippo et al. Intensive Care Med Exp. .

Abstract

Purpose: Assessment of the inferior vena cava (IVC) respiratory variation may be clinically useful for the estimation of fluid-responsiveness and venous congestion; however, imaging from subcostal (SC, sagittal) region is not always feasible. It is unclear if coronal trans-hepatic (TH) IVC imaging provides interchangeable results. The use of artificial intelligence (AI) with automated border tracking may be helpful as part of point-of-care ultrasound but it needs validation.

Methods: Prospective observational study conducted in spontaneously breathing healthy volunteers with assessment of IVC collapsibility (IVCc) in SC and TH imaging, with measures taken in M-mode or with AI software. We calculated mean bias and limits of agreement (LoA), and the intra-class correlation (ICC) coefficient with their 95% confidence intervals.

Results: Sixty volunteers were included; IVC was not visualized in five of them (n = 2, both SC and TH windows, 3.3%; n = 3 in TH approach, 5%). Compared with M-mode, AI showed good accuracy both for SC (IVCc: bias - 0.7%, LoA [- 24.9; 23.6]) and TH approach (IVCc: bias 3.7%, LoA [- 14.9; 22.3]). The ICC coefficients showed moderate reliability: 0.57 [0.36; 0.73] in SC, and 0.72 [0.55; 0.83] in TH. Comparing anatomical sites (SC vs TH), results produced by M-mode were not interchangeable (IVCc: bias 13.9%, LoA [- 18.1; 45.8]). When this evaluation was performed with AI, such difference became smaller: IVCc bias 7.7%, LoA [- 19.2; 34.6]. The correlation between SC and TH assessments was poor for M-mode (ICC = 0.08 [- 0.18; 0.34]) while moderate for AI (ICC = 0.69 [0.52; 0.81]).

Conclusions: The use of AI shows good accuracy when compared with the traditional M-mode IVC assessment, both for SC and TH imaging. Although AI reduces differences between sagittal and coronal IVC measurements, results from these sites are not interchangeable.

Keywords: Critical care; Inferior vena cava; Subcostal; Transhepatic; Ultrasound.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Bland–Altman plot for the inferior vena cava collapsibility index (IVCc) measured in subcostal (SC) site with standard M-mode or artificial intelligence (AI). SD: standard deviation
Fig. 2
Fig. 2
Bland–Altman plot for the inferior vena cava collapsibility index (IVCc) measured in Transhepatic (TH) site with standard M-mode or artificial intelligence (AI). SD: standard deviation
Fig. 3
Fig. 3
Bland–Altman plot for the inferior vena cava collapsibility index (IVCc) measured with standard M-mode in two different sites: subcostal (SC) and transhepatic (TH). SD: standard deviation
Fig. 4
Fig. 4
Bland–Altman plot for the inferior vena cava collapsibility index (IVCc) measured with artificial intelligence (AI) mode in two different sites: subcostal (SC) and transhepatic (TH). SD: standard deviation
See this image and copyright information in PMC

References

    1. Boulain T, Cecconi M. Can one size fit all? The fine line between fluid overload and hypovolemia. Intensive Care Med. 2015;41:544–546. doi: 10.1007/s00134-015-3683-7. - DOI - PubMed
    1. Sanfilippo F, Messina A, Cecconi M, Astuto M (2020) Ten answers to key questions for fluid management in intensive care. Medicina intensiva - PubMed
    1. Dhondup T, Tien JC, Marquez A, Kennedy CC, Gajic O, Kashani KB. Association of negative fluid balance during the de-escalation phase of sepsis management with mortality: a cohort study. J Crit Care. 2020;55:16–21. doi: 10.1016/j.jcrc.2019.09.025. - DOI - PubMed
    1. Zhang L, Xu F, Li S, Zheng X, Zheng S, Liu H, Lyu J, Yin H. Influence of fluid balance on the prognosis of patients with sepsis. Ann Intensive Care. 2021;21:269. - PMC - PubMed
    1. Sanfilippo F, Scolletta S (2017) Fluids in cardiac surgery: sailing calm on a stormy sea? Common sense is the guidance. Minerva anestesiologica - PubMed

LinkOut - more resources