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A genomic storm in critically injured humans
Critical injury in humans induces a genomic storm with simultaneous changes in expression of innate and adaptive immunity genes
Inferior Vena Cava Measurement With Ultrasound: What is The Best View and Best Mode?
Introduction: Intravascular volume status is an important clinical consideration in the management of
the critically ill. Point-of-care ultrasonography (POCUS) has gained popularity as a non-invasive means
of intravascular volume assessment via examination of the inferior vena cava (IVC). However, there are
limited data comparing different acquisition techniques for IVC measurement by POCUS. The goal of this
evaluation was to determine the reliability of three IVC acquisition techniques for volume assessment: subxiphoid
transabdominal long axis (LA), transabdominal short axis (SA), and right lateral transabdominal
coronal long axis (CLA) (aka “rescue view”).
Methods: Volunteers were evaluated by three experienced emergency physician sonographers (EP). Gray
scale (B-mode) and motion-mode (M-mode) diameters were measured and IVC collapsibility index (IVCCI)
calculated for three anatomic views (LA, SA, CLA). For each IVC measurement, we calculated descriptive
statistics, intra-class correlation coefficients (ICC), and two-way univariate analyses of variance.
Results: EPs evaluated 39 volunteers, yielding 351 total US measurements. Measurements of the three
views had similar means (LA 1.9 ± 0.4cm; SA 1.9 ± 0.4cm; CLA 2.0 ± 0.5cm). For B-Mode, LA had the
highest ICC (0.86, 95% CI [0.76-0.92]) while CLA had the poorest ICC (0.74, 95% CI [0.56-0.85]). ICCs for
all M-mode IVCCI were low. Significant interaction effects between anatomical view and EP were observed
for B-mode and M-mode measurements. Post-hoc analyses revealed difficulty in consistent view acquisition
between EPs.
Conclusion: Inter-rater reliability of the IVC by EPs was highest for B-mode LA and poorest for all M-Mode
IVC collapsibility indices (IVCCI). These results suggest that B-mode LA holds the most promise to deliver
reliable measures of IVC diameter. Future studies may focus on validation in a clinical setting as well as
comparison to a reference standard. [West J Emerg Med. 2017;18(3)496-501.