الفهرس 
Introduction and aim of the work
Normal FindingsOnly 14 pages are availabe for public view
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Abstract
Determination of body fluid volume status in critically-ill patients is important both for diagnosis and management. CVP monitoring is a mainstay of estimating intravascular fluid status and cardiac preload in critically-ill patients. However, CVP monitoring requires placement of a central venous catheter, which is often difficult in an urgent situation, an invasive maneuver with multiple complications and time-consuming emergency procedure. There are some alternative and noninvasive methods for estimating the intravascular volume such as measuring the IVC diameter and volume status by ultrasonography.
This study was conducted in Assuit University at Chest Department, Respiratory ICU in period between March 2016 and March 2017. The aim of the study was support usage of ultrasound as guidance for central venous catheter insertion and to determine the correlation between central venous pressure measured by conventional central access and inferior vena cava diameter measured by ultrasound.
Central venous catheter was inserted by a guidance of neck ultrasound, as a result none of the studied group developed any immediate complication from CVC insertion.
The study included 50 patients with mean age was (65.8 + 12.1) years. COPD and pneumonia were the most common diagnosis of the patients included in the study, and cardiovascular diseases and diabetes mellitus were the most common associated comorbidities.
Vomiting and diarrhea were the most common cause of fluid loss, and dry tongue and skin pinch test were the most common signs of dehydration. Most of the patients were conscious (82%) and only (18%) were disturbed conscious level.
Among different respiratory phases of IVC diameter and the IVC collapsibility index (caval index), we found that there was a significant correlation between CVP and caval index. Also we found that CVP and caval index were negatively correlated. Moreover we can predict CVP measurement by IVC sonography.
Recommendations:
1- Usage of neck ultrasound as a guidance for CVC insertion instead of blind CVC insertion is recommended to decrease the risk of complications
2- Application of IVC assessment and so caval index calculation instead of using CVP measurement for assessing fluid status of the critically-ill patients is a rapid, safe, applicable ,cost effective and reproducible maneuver .
3- Increase training on neck and chest ultrasound and help to improve the experience to use this maneuver not only between pulmonologists but also among all the intensivists