Reference Value for Vascular Pedicle Width in Pediatric Populations
There is currently no established reference value for vascular pedicle width specifically in pediatric populations based on the available evidence. The existing research on vascular pedicle width (VPW) focuses primarily on adult populations, with 70 mm being the standard cutoff value for differentiating between high versus normal to low intravascular volume status in adults 1.
Adult VPW Reference Values
In adult critical care settings:
- A VPW of 70 mm is considered the best cutoff for differentiating high versus normal to low intravascular volume status 1
- A VPW of 64 mm has been shown to predict fluid repletion with a positive predictive value of 88.5% 2
- VPW ≤67 mm demonstrates 71% sensitivity and 68% specificity for achieving pulmonary artery occlusion pressure (PAOP) <8 mmHg 3
- VPW ≥72 mm demonstrates 61.4% sensitivity and 61% specificity for identifying PAOP ≥18 mmHg 3
Clinical Utility of VPW
VPW measurements can:
- Increase accuracy of clinical and radiographic assessment of intravascular volume status by 15-30% 1
- Correlate with PAOP (r = 0.41) better than with central venous pressure (CVP) (r = 0.21) 3
- Correlate with inferior vena cava diameter (Pearson's r = 0.64) 2
- Be particularly valuable when used serially in the same patient 1
Limitations for Pediatric Application
The lack of pediatric-specific VPW reference values represents a significant gap in the literature. Given that pediatric patients have different anatomical proportions and vascular dimensions compared to adults, adult reference values cannot be directly applied to children.
While the RAND Corporation-University of California methodology has been used to develop appropriateness criteria for pediatric vascular access 4, this work does not specifically address VPW measurements in children.