segunda-feira, janeiro 28, 2013
Veia cava e o volume.
Is the Inferior Vena Cava Really Superior?⁎⁎
Mark H. Drazner, MD, MSc
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The time has come to assess whether routine incorporation of hand-carried echocardiography to assess filling pressures can improve clinical outcomes of patients with heart failure as compared with therapy based upon a carefully performed history and physical examination. An evidence base for such a trial is beginning to emerge. In a study in which hand-carried echocardiography, BNP levels, and clinical evaluation were used to estimate elevated LV filling pressures (pulmonary capillary wedge pressure >15 mm Hg) in patients with chronic systolic heart failure, IVCmax had the highest AUC (0.89) followed by BNP levels (0.88), evaluation of JVP (0.82), and a clinical congestion score (0.74) (14). Importantly, the combination of these parameters had better operating characteristics (AUC 0.97) than any individual test, highlighting the potential utility of combining hand-carried echocardiography with the traditional history and physical examination.
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In a multivariable Cox regression model, including NT-proBNP, only increasing IVC diameter, urea, and the trans-tricuspid systolic gradient independently predicted a poor outcome.
Medindo no local adequado e sem erro de posicionamento, a veia cava inferior é muito precisa para a volemia, acredito.
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