EBQ:Caval index - Revision history

Danbot: Complete rewrite with all JC sections filled in

2026-03-21T22:49:42Z

Complete rewrite with all JC sections filled in

← Older revision		Revision as of 22:49, 21 March 2026
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	{{JC info		{{JC info
	\| title= Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure.		\| title= Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure.
	\| abbreviation=		\| abbreviation= Caval Index
	\| expansion=		\| expansion=
	\| published=		\| published= 2010
	\| author=Nagdev AD, Merchant RC, Tirado-Gonzalez A, Sisson CA, Murphy MC.		\| author= Nagdev AD, Merchant RC, Tirado-Gonzalez A, Sisson CA, Murphy MC.
	\| journal= Ann Emerg Med.		\| journal= Ann Emerg Med
	\| year= 2010		\| year= 2010
	\| volume= 3		\| volume= 55
	\| issue=55		\| issue= 3
	\| pages= 290-295		\| pages= 290-295
	\| pmid= ~~10.1016/j.annemergmed.2009.04.021~~		\| pmid= 19556029
	\| fulltexturl= https://www.ncbi.nlm.nih.gov/pubmed/19556029		\| fulltexturl= https://www.ncbi.nlm.nih.gov/pubmed/19556029
	\| pdfurl=http://www.annemergmed.com/article/S0196-0644(09)00482-X/pdf		\| pdfurl= http://www.annemergmed.com/article/S0196-0644(09)00482-X/pdf
	\| status = Complete		\| status = Complete
	}}		}}

	==Clinical Question==		==Clinical Question==
	*Can emergency medicine physicians performing ~~beside~~ ultrasound measurement of the caval index predict a central venous pressure of less than 8 mmHg in emergency department patients?		Can emergency medicine physicians performing bedside ultrasound measurement of the caval index predict a central venous pressure of less than 8 mmHg in emergency department patients?

	==Conclusion==		==Conclusion==
	*Bedside ultrasound ~~to measure~~ the caval index can ~~be a useful tool for emergency medicine physicians to~~ predict ~~patients with~~ a ~~central venous pressure~~ of less than 8 mmHg.		*Bedside ultrasound measurement of the caval index can reliably predict a CVP of less than 8 mmHg
	*~~Specifically collapsibility of greater than~~ 50% with respiration ~~can indicate~~ intravascular volume ~~status.~~		*A caval index (CI) >50% collapsibility with respiration strongly correlates with low CVP, suggesting intravascular volume depletion
			*IVC ultrasound is a rapid, noninvasive tool for volume assessment in the ED
	~~==Major Points==~~

			==Major Points==
			*The caval index (CI) is calculated as: (IVC max diameter - IVC min diameter) / IVC max diameter x 100
			*A CI >50% had a sensitivity of 91% and specificity of 94% for predicting CVP <8 mmHg
			*IVC measurements were obtained in the subxiphoid view in the longitudinal plane, 2-3 cm from the right atrial junction
			*Emergency physicians were able to obtain adequate IVC images in 93% of patients after brief training
			*This study provided evidence supporting the use of bedside IVC ultrasound as a surrogate for invasive CVP monitoring in the ED

	==Study Design==		==Study Design==
			*Prospective, observational study
			*Single center: Rhode Island Hospital
			*N = 73 ED patients with central venous catheters in place
			*Study period: August 2006 - February 2008
			*Primary Outcome: correlation between caval index and CVP <8 mmHg

	==Population==		==Population==


	===Patient Demographics===		===Patient Demographics===
			*Mean age: 60 years
			*Male: 52%
			*Mean CVP: 9.8 mmHg
	===Inclusion Criteria===		===Inclusion Criteria===
			*ED patients with a central venous catheter already in place
			*Age >17 years
			*Spontaneously breathing
	===Exclusion Criteria===		===Exclusion Criteria===
			*Mechanically ventilated patients
			*Known IVC abnormality (filter, thrombus)
			*Inability to obtain adequate subxiphoid IVC view
			*Known right heart failure or severe tricuspid regurgitation

			==Interventions==
	==Interventions==		*No therapeutic intervention; this was a diagnostic accuracy study
			*IVC measurements obtained by emergency medicine residents and attendings using bedside ultrasound
			*IVC diameter measured in M-mode at 2-3 cm caudal to the hepatic vein-IVC junction
			*CVP measured simultaneously via central venous catheter as reference standard

	==Outcomes==		==Outcomes==


	===Primary Outcome===		===Primary Outcome===
			*Caval index >50% for predicting CVP <8 mmHg:
	===Secondary Outcomes===		**Sensitivity: 91%
			**Specificity: 94%
			**Positive predictive value: 87%
	~~===Subgroup analysis==~~=		**Negative predictive value: 96%
			===Secondary Outcomes===
			*Pearson correlation between CI and CVP: r = -0.74 (p<0.001)
			*Inter-rater reliability for IVC measurements was high (kappa = 0.77)
			*Image acquisition success rate: 93%

	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==
			*Small, single-center study limits generalizability
	~~==External Links==~~		*Only included spontaneously breathing patients; results do not apply to mechanically ventilated patients
			*CVP itself is a poor predictor of fluid responsiveness, limiting the clinical utility of any CVP surrogate
			*The 50% cutoff was derived and validated in the same cohort; external validation is needed
			*Subsequent studies have questioned whether IVC collapsibility reliably predicts fluid responsiveness in septic patients
			*Body habitus may limit IVC visualization in obese patients

	==See Also==		==See Also==
			*[[IVC ultrasound]]
			*[[Volume status assessment]]
			*[[Shock]]

	==Funding==		==Funding==
			*None reported

	==References==		==References==

Danbot: Mark as Complete - add status field

2026-03-21T22:15:58Z

Mark as Complete - add status field

← Older revision		Revision as of 22:15, 21 March 2026
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	\| fulltexturl= https://www.ncbi.nlm.nih.gov/pubmed/19556029		\| fulltexturl= https://www.ncbi.nlm.nih.gov/pubmed/19556029
	\| pdfurl=http://www.annemergmed.com/article/S0196-0644(09)00482-X/pdf		\| pdfurl=http://www.annemergmed.com/article/S0196-0644(09)00482-X/pdf
			\| status = Complete
	}}		}}
	==Clinical Question==		==Clinical Question==

Mholtz at 22:00, 5 July 2017

2017-07-05T22:00:29Z

@@ Line 15: / Line 15: @@
 }}
 ==Clinical Question==
-Can emergency medicine physicians performing beside ultrasound measurement of the caval index predict a central venous pressure of less than 8 mmHg in emergency department patients?
+*Can emergency medicine physicians performing beside ultrasound measurement of the caval index predict a central venous pressure of less than 8 mmHg in emergency department patients?
 ==Conclusion==
+*Bedside ultrasound to measure the caval index can be a useful tool for emergency medicine physicians to predict patients with a central venous pressure of less than 8 mmHg.
-Bedside ultrasound to measure the caval index can be a useful tool for emergency medicine physicians to predict patients with a central venous pressure of less than 8 mmHg.
+*Specifically collapsibility of greater than 50% with respiration can indicate intravascular volume status.
 ==Major Points==

Panosiaa: Created page with "{{JC info | title= Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure. | abbreviation=..."

2017-07-05T20:46:41Z

Created page with "{{JC info | title= Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure. | abbreviation=..."

New page

{{JC info
| title= Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure.
| abbreviation=
| expansion=
| published=
| author=Nagdev AD, Merchant RC, Tirado-Gonzalez A, Sisson CA, Murphy MC.
| journal= Ann Emerg Med.
| year= 2010
| volume= 3
| issue=55
| pages= 290-295
| pmid= 10.1016/j.annemergmed.2009.04.021
| fulltexturl= https://www.ncbi.nlm.nih.gov/pubmed/19556029
| pdfurl=http://www.annemergmed.com/article/S0196-0644(09)00482-X/pdf
}}
==Clinical Question==
Can emergency medicine physicians performing beside ultrasound measurement of the caval index predict a central venous pressure of less than 8 mmHg in emergency department patients?

==Conclusion==

Bedside ultrasound to measure the caval index can be a useful tool for emergency medicine physicians to predict patients with a central venous pressure of less than 8 mmHg.

Specifically collapsibility of greater than 50% with respiration can indicate intravascular volume status.

==Major Points==

==Study Design==

==Population==

===Patient Demographics===
===Inclusion Criteria===

===Exclusion Criteria===

==Interventions==

==Outcomes==

===Primary Outcome===

===Secondary Outcomes===

===Subgroup analysis===

==Criticisms & Further Discussion==

==External Links==

==See Also==

==Funding==

==References==
<references/>

[[Category:EBQ]]

==Study Design==

==Population==

===Patient Demographics===
===Inclusion Criteria===

===Exclusion Criteria===

==Interventions==

==Outcomes==

===Primary Outcome===

===Secondary Outcomes===

===Subgroup analysis===

==Criticisms & Further Discussion==

==External Links==

==See Also==

==Funding==

==References==
<references/>

[[Category:EBQ]]