Diagnostic Accuracy of Ultrasonographic Respiratory Variation in the Inferior Vena Cava, Subclavian Vein, Internal Jugular Vein, and Femoral Vein Diameter to Predict Fluid Responsiveness: A Systematic Review and Meta-Analysis

Kim, Do Wan; Chung, Seungwoo; Kang, Wu Seong; Kim, Joong Suck

doi:10.3390/diagnostics12010049

Cited by 20 publications

(21 citation statements)

References 65 publications

(282 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a previous study by Aissaoui et al ( 21 ), ΔVTI-PLR (velocity time integral of the left ventricular outflow tract changes induced by passive leg raise) predicted PIH with a 0.89 AUC under the ROC curve (95% CI: 0.80–0.97) at a cutoff of 18% (88% sensitivity and 84% specificity) in patients >50 years of age. Similar to ultrasound-based IVC parameters ( 22 ), the mechanism of ΔVTI-PLR in predicting PIH is based on fluid responsiveness assessment ( 23 ). ΔVTI-PLR was not selected in the current study due to technical difficulty ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

Maximum inferior vena cava diameter predicts post-induction hypotension in hypertensive patients undergoing non-cardiac surgery under general anesthesia: A prospective cohort study

Zhang

Gao²,

Xiang³

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

BackgroundInferior vena cava (IVC) ultrasonography is a reliable variable that predicts post-induction hypotension (PIH) in patients undergoing surgery under general anesthesia. However, in patients with hypertension, the predictive performance of ultrasound IVC measurements needs further exploration.MethodsThis is a prospective cohort study. Adult patients with existing hypertension scheduled to undergo non-cardiac surgery under general anesthesia were eligible. An abdominal ultrasound examination was conducted immediately prior to anesthesia induction (0.03 mg kg–1 midazolam, 0.3 mg kg–1 etomidate, 0.4 μg kg–1 sufentanil, and 0.6 mg kg–1 rocuronium). IVC collapsibility index (IVC-CI) was calculated as (dIVCmax–dIVCmin)/dIVCmax, where dIVCmax and dIVCmin represent the maximum and minimum IVC diameters at the end of expiration and inspiration, respectively. PIH was defined as a reduction of mean arterial pressure (MAP) by >30% of the baseline or to <60 mmHg within 10 min after endotracheal intubation. The diagnostic performance of IVC-CI, dIVCmax, and dIVCmin in predicting PIH was also examined in a group of normotensive patients receiving non-cardiac surgery under the same anesthesia protocol.ResultsA total of 51 hypertensive patients (61 ± 13 years of age, 31 women) and 52 normotensive patients (42 ± 13 years of age, 35 women) were included in the final analysis. PIH occurred in 33 (64.7%) hypertensive patients and 19 (36.5%) normotensive patients. In normotensive patients, the area under the receiver operating curve (AUC) in predicting PIH was 0.896 (95% confidence interval [CI]: 0.804–0.987) for IVC-CI, 0.770 (95% CI: 0.633–0.908) for dIVCmax, and 0.868 (95% CI: 0.773–0.963) for dIVCmin. In hypertensive patients, the AUC in predicting PIH was 0.523 (95% CI: 0.354–0.691) for IVC-CI, 0.752 (95% CI: 0.621–0.883) for dIVCmax, and 0.715 (95% CI: 0.571–0.858) for dIVCmin. At the optimal cutoff (1.24 cm), dIVCmax had 54.5% (18/33) sensitivity and 94.4% (17/18) specificity.ConclusionIn hypertensive patients, IVC-CI is unsuitable for predicting PIH, and dIVCmax is an alternative measure with promising performance.Clinical trial registration[http://www.chictr.org.cn/], identifier [ChiCTR2000034853].

show abstract

Section: Discussionmentioning

confidence: 99%

Maximum inferior vena cava diameter predicts post-induction hypotension in hypertensive patients undergoing non-cardiac surgery under general anesthesia: A prospective cohort study

Zhang

Gao²,

Xiang³

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…However, the authors did not conduct a meta-analysis. Our previous meta-analysis demonstrated that ultrasound-guided measurement of the variability of IVC diameter had high accuracy (AUC of 0.86) for volume responsibility [ 5 ]. The diameter of the IVC varies with inspiration and expiration and reflects cardiac preload.…”

Section: Discussionmentioning

confidence: 99%

“…In general, during CT, patients are recommended to pause their breathing after full inspiration to enhance the image quality of chest CT, which is usually performed simultaneously with abdominal CT. During inspiration, thoracic pressure decreases, and venous return increases [ 5 ]. Consequently, IVC diameter decreases during inspiration in patients with spontaneous breathing [ 5 ]. Therefore, IVC diameter on CT may be representative of the minimum diameter of the IVC.…”

Section: Discussionmentioning

confidence: 99%

“…These scoring systems are generally based on point-of-care ultrasounds, which detect free fluid on the abdomen or pelvic cavity. In our previous systematic review and meta-analysis, ultrasounds measuring the respiratory variation of the inferior vena cava (IVC) were shown to accurately predict volume responsibility with a pooled AUC of 0.86 [ 5 ]. In addition, variation of IVC diameter has been shown to predict volume status in many previous studies [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…In our previous systematic review and meta-analysis, ultrasounds measuring the respiratory variation of the inferior vena cava (IVC) were shown to accurately predict volume responsibility with a pooled AUC of 0.86 [ 5 ]. In addition, variation of IVC diameter has been shown to predict volume status in many previous studies [ 5 ]. However, ultrasound-guided measuring depends on the practitioner’s skill or experience.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Flat Inferior Vena Cava on Computed Tomography for Predicting Shock and Mortality in Trauma: A Meta-Analysis

2022

Self Cite

View full text Add to dashboard Cite

Hypovolemia may be underestimated due to compensatory mechanisms. In this systematic review and meta-analysis, we investigated the diagnostic accuracy of a flat inferior vena cava (IVC) on computed tomography (CT) for predicting the development of shock and mortality in trauma patients. Relevant studies were obtained by searching PubMed, EMBASE, and Cochrane databases (articles up to 16 September 2022). The number of 2-by-2 contingency tables for the index test were collected. We adopted the Bayesian bivariate random-effects meta-analysis model. Twelve studies comprising a total of 1706 patients were included. The flat IVC on CT showed 0.46 pooled sensitivity (95% credible interval [CrI] 0.32–0.63), 0.87 pooled specificity (95% CrI 0.78–0.94), and 0.78 pooled AUC (95% CrI 0.58–0.93) for the development of shock. The flat IVC for mortality showed 0.48 pooled sensitivity (95% CrI 0.21–0.94), 0.70 pooled specificity (95% CrI 0.47–0.88), and 0.60 pooled AUC (95% CrI 0.26–0.89). Regarding the development of shock, flat IVC provided acceptable accuracy with high specificity. Regarding in-hospital mortality, the flat IVC showed poor accuracy. However, these results should be interpreted with caution due to the high risk of bias and substantial heterogeneity in some included studies.

show abstract

The 2023 Core Content of advanced emergency medicine ultrasonography

Adhikari,

Leo,

Liu

et al. 2023

JACEP Open

View full text Add to dashboard Cite

In February 2023, the American Board of Emergency Medicine (ABEM) approved modifications to the Advanced Emergency Medicine Ultrasonography (AEMUS) Core Content, which defines the areas of knowledge considered essential for the practice of AEMUS. This manuscript serves as a revision of the AEMUS Core Content originally published in 2014. The revision of the Core Content for AEMUS training aims to establish standardized education and qualifications necessary for AEMUS fellowship program leadership, clinical application, administration, quality improvement, and research. The Core Content provides the organizational framework and serves as the basis for the development of content for the Focused Practice Examination (FPE) administered by ABEM. AEMUS fellowship directors may reference the Core Content when designing AEMUS fellowship curricula to help prepare graduates for the autonomous practice of AEMUS and the FPE. In this article, an updated revision of the previously published AEMUS Core Content is detailed, and the entire development of the Core Content is presented.

show abstract

Diagnostic Accuracy of Ultrasonographic Respiratory Variation in the Inferior Vena Cava, Subclavian Vein, Internal Jugular Vein, and Femoral Vein Diameter to Predict Fluid Responsiveness: A Systematic Review and Meta-Analysis

Cited by 20 publications

References 65 publications

Maximum inferior vena cava diameter predicts post-induction hypotension in hypertensive patients undergoing non-cardiac surgery under general anesthesia: A prospective cohort study

Maximum inferior vena cava diameter predicts post-induction hypotension in hypertensive patients undergoing non-cardiac surgery under general anesthesia: A prospective cohort study

Flat Inferior Vena Cava on Computed Tomography for Predicting Shock and Mortality in Trauma: A Meta-Analysis

The 2023 Core Content of advanced emergency medicine ultrasonography

Contact Info

Product

Resources

About