Ultrasonographic assessment to identify early phase of hypovolemic shock in traumatic patients using IVC:AA diameter index
Keywords:
Hypovolemic Shock, Trauma, Ultrasonography, Inferior Vena Cava, Abdominal Aorta, IVC:AA Index, Emergency Medicine, Early Diagnosis, Fluid Resuscitation, FAST ScanAbstract
Introduction and Objectives: Trauma remains a leading cause of morbidity and mortality, especially in the reproductive age group. Hypovolemic shock, a major consequence of trauma, often lacks classical clinical features in its early stages, making early diagnosis challenging. Traditional parameters such as hypotension, tachycardia, and laboratory markers are often non-specific. The inferior vena cava (IVC) to abdominal aorta (AA) diameter index (IVC:AA index) has emerged as a reliable, non-invasive, bedside ultrasonographic tool for assessing early hypovolemia (Class I shock). This study evaluates the efficacy of the IVC:AA index in detecting early hypovolemia, potentially aiding timely intervention and improving patient outcomes.
Materials and Methods: A prospective analytical study was conducted in the Department of Emergency Medicine, VMKVMCH, Salem, from June 2021 to June 2022, following ethical committee approval. The study included trauma patients undergoing ultrasonographic evaluation of the IVC and AA using a Mindray M5 portable ultrasound with a 3.5–5 MHz curvilinear probe. Measurements were taken at standardized anatomical landmarks in supine patients. The IVC diameter was measured 2 cm from the right atrium inlet, while the AA diameter was measured 10 mm above the celiac trunk. Three readings were recorded to obtain mean values. Correlations were analyzed between IVC:AA ratios, shock index (SI), and patient demographics. Statistical analysis was conducted using SPSS, with a p-value <0.05 considered significant.
Results: A total of trauma patients were analyzed. The mean IVC:AA index was significantly lower in patients with early hypovolemia. A cut-off value of 1.14 was determined as indicative of Class I hypovolemic shock. The index correlated strongly with vital signs, including blood pressure and SI. Patients with lower IVC:AA indices required early fluid resuscitation. The study confirmed the reliability of ultrasonographic assessment in detecting early hypovolemia before traditional clinical signs manifest.
Conclusion: The IVC:AA index is an effective, bedside ultrasonographic tool for early detection of hypovolemic shock in trauma patients. Its integration into emergency protocols can facilitate timely resuscitation and improve patient outcomes.
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