From the Research
The width of the vascular pedicle is approximately 48 +/- 5.0 mm in normal subjects, as measured in the erect position, and can be estimated within clinically useful limits by inspection, taking into account the patient's physique 1.
Key Points to Consider
- The vascular pedicle width (VPW) is a radiographic measurement that helps assess a patient's intravascular volume status.
- VPW increases with conditions like heart failure, renal failure, and fluid overload, while it decreases with hypovolemia and dehydration.
- The normal VPW range is approximately 43 to 53 mm, with measurements above 53 mm suggesting volume overload and below 43 mm indicating volume depletion.
- To measure VPW, locate the point where the superior vena cava crosses the right main bronchus and the point where the left subclavian artery exits the aortic arch, then measure the horizontal distance between these points.
- Serial measurements are more valuable than a single reading as they can track changes in a patient's volume status over time.
Clinical Application
- VPW is particularly useful in critically ill patients to guide fluid management decisions.
- It should be interpreted alongside other clinical parameters such as vital signs, physical examination findings, and laboratory values for comprehensive patient evaluation.
- The clinical value of VPW lies in its ability to provide a non-invasive assessment of volume status.
Evidence-Based Recommendation
- The most recent and highest quality study 1 provides the basis for the normal VPW range and its clinical application.
- This study measured VPW in 83 normal volunteers and 42 patients with cardiac disease, providing a robust dataset for estimating normal VPW values.
- The study's findings are consistent with other research in the field, including studies on the use of VPW in critically ill patients 2 and its correlation with body weight and surface area 1.