Inferior vena cava peak velocity versus collapsibility index to predict volume status in patients with gastrointestinal bleeding: A pilot study

Onur Cem Büyüktaş1, Yunus Emre Özlüer2, Ahmet Melih Savaş2, Ertuğ Dinçer3

1Department of Emergency Medicine, Erzurum City Hospital, Erzurum, Türkiye
2Department of Emergency Medicine, Aydin Adnan Menderes University Faculty of Medicine, Aydin, Türkiye
3Department of Emergency Medicine, Bilecik Training and Research Hospital, Bilecik, Türkiye

Keywords: Continuous wave Doppler, inferior vena cava, peak velocity, stroke volume variation, volume status

Abstract

OBJECTIVES: Patients presenting to the emergency department (ED) with hemorrhagic shock secondary to acute gastrointestinal (GI) bleeding represent a substantial proportion of the critically ill population. Accurate evaluation of intravascular volume status in these patients is crucial for guiding fluid resuscitation. However, the limitations of invasive methods and inferior vena cava (IVC) diameter/collapsibility measurements in assessing intravascular volume have been widely discussed in the literature. Despite their validation, noninvasive hemodynamic monitoring techniques remain underutilized in the ED. Therefore, the present study aimed to investigate the predictive value of IVC blood flow velocity measured by Doppler ultrasonography in intravascular volume assessment and to compare it with the IVC collapsibility index. Electrical velocity measurement was used as a surrogate marker of volume deficit.

METHODS: Eighteen patients presenting with a preliminary diagnosis of acute GI bleeding were included in the study. The study population consisted solely of patients with suspected hypovolemia; therefore, no normovolemic control group was included in the study. Demographic, vital, and laboratory data were recorded, along with IVC diameter, collapsibility, IVC peak velocity measured by continuous wave Doppler, and noninvasive hemodynamic monitoring parameters at admission, at the 30th and 60th min, and immediately after completion of fluid replacement. All data were subjected to statistical analysis.

RESULTS: A significant correlation was observed between initial IVC peak velocity and stroke volume variation at admission (P = 0.009). The measurement demonstrated a specificity of 100% and a sensitivity of 84%, although the confidence interval was wide due to the small number of patients without volume deficit. No statistically significant differences were detected at the other time points. This can be explained by the ongoing bleeding and the lack of a valid gold standard.

CONCLUSION: Measurement of IVC peak velocity was found to be a significant predictor of hypovolemia, although it showed limited utility for volume monitoring. Furthermore, it demonstrated superior performance compared to IVC diameter and collapsibility measurements. However, the study does not evaluate its ability to distinguish hypovolemia from true normovolemia.

How to cite this article: Büyüktaş OC, Özlüer YE, Savaş AM, Dinçer E. Inferior vena cava peak velocity versus collapsibility index to predict volume status in patients with gastrointestinal bleeding: A pilot study. Turk J Emerg Med 2026;26:288-95.