Sonographic measurement of inferior vena cava diameter in assessment of volume status in pediatric shock: A prospective observational study.

BackgroundAccurate assessment of intravascular volume status in pediatric shock remains a clinical challenge, often relying on subjective and invasive methods. Bedside ultrasonography of the inferior vena cava (IVC) has emerged as a promising, non-invasive modality to estimate volume status. This study aimed to evaluate the IVC diameter and IVC-to-aortic (IVC/Ao) ratio as objective indicators of hypovolemia in children using ultrasound. Objectives: To obtain and analyze data on IVC diameter and IVC/Ao ratio measured by sonography for assessing intravascular volume status in infants and children with clinical shock compared to euvolemic controls. MethodsIn this prospective observational study, 60 children aged 1 month to 18 years admitted with clinical shock were compared with 60 age-matched euvolemic controls. Sociodemographic characteristics, including age and sex, were recorded. Maximum sagittal IVC diameter, transverse aortic diameter, and IVC/Ao ratio were measured using bedside ultrasound. ResultsThe mean age of participants was comparable; the male-to-female ratio was 0.6:1 in the shock group and 1:1.2 in controls. The mean IVC diameter was significantly lower in the shock group (0.99±0.45 cm) than in controls (1.46±0.52 cm; p<0.001), indicating intravascular hypovolemia. The IVC/Ao ratio was also reduced in shock cases (0.65±0.10) compared to controls (0.98±0.09; p<0.001). No significant difference was observed in aortic diameters. ConclusionUltrasound-derived measurements of IVC diameter and IVC/Ao ratio are reliable non-invasive indicators of hypovolemia in pediatric shock. RecommendationsBedside ultrasound should be integrated into the routine evaluation of children with suspected shock to improve early detection and guide fluid management.