Prevention of arterial hypotension after spinal anaesthesia using vena cava ultrasound to guide fluid management

Ceruti, Samuele; Anselmi, Luciano; Minotti, Bruno; Franceschini, D.; Aguirre, José; Borgeat, Alain; Saporito, Andrea

doi:10.1016/j.bja.2017.08.001

Cited by 59 publications

(64 citation statements)

References 35 publications

(22 reference statements)

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“…The IVCCI had high specificity and low sensitivity in experiments by Mueller et al when a cutoff level of >40% was used to predict volume responsiveness [14]. However, this performance as a diagnostic tool is, on the one hand, similar to that observed in our experiments in the case of the value of 50%, but on the other hand, Mačiulienė et al failed to detect a prognostic role of the IVCCI [19], while another recent trial reported an IVCCI-based fluid replacement strategy as a useful tool to reduce the incidence of hypotension [20].…”

Section: Discussionsupporting

confidence: 86%

Role of inferior vena cava collapsibility index in the prediction of hypotension associated with general anesthesia: an observational study

Szabó

Bozó

Darvas

et al. 2019

Preprint

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Background: Intraoperative hypotension increases 30-day mortality and the risks of myocardial injury and acute renal failure. Patients with inadequate volume reserve before the induction of anesthesia are highly exposed. The identification of latent hypovolemia is therefore crucial. Ultrasonographic measurement of the inferior vena cava collapsibility index (IVCCI) is able to detect volume responsiveness in circulatory shock. No current evidence is available regarding whether preoperative measurement of the IVCCI could identify patients at high risk for hypotension associated with general anesthesia. Methods: A total of 102 patients undergoing elective general surgery under general anesthesia with standardized propofol induction were recruited for this prospective observational study. The IVCCI was measured under spontaneous breathing. A collapsing (IVCCI≧50%) (CI+) and a noncollapsing (CI-) group were formed. Immediate postinduction changes in systolic and mean blood pressure were compared. The performance of the IVCCI as a diagnostic tool for predicting hypotension (systolic pressure <90 mmHg or a ≥30% drop from the baseline) was evaluated by ROC curve analysis. Results: A total of 83 patients were available for analysis, with 20 in the CI+ and 63 in the CI- group, we excluded 19 previously eligible patients due to inadequate visualization of the IVC (7 cases), lack of adherence to the protocol (8 cases), missing data (2 cases) or change in anesthesiologic management (2 cases). The mean decrease in systolic pressure in the CI+ group was 53.8±15.3 compared to 35.8±18.1 mmHg in CI- patients (P=0.0001). The relative mean arterial pressure change medians were 34.1% (IQR 23.2%-43.0%) and 24.2% (IQR 17.2%-30.2%), respectively (P=0.0029). The ROC curve analysis for IVCCI showed an AUC of 64.8% (95%CI 52.1-77.5%). The selected 50% level of the IVCCI had a sensitivity of only 45.5% (95%CI 28.1-63.7%), but the specificity was high at 90.0% (78.2-96.7%). The positive predictive value was 75.0% (95%CI 50.9-91.3%), and the negative predictive value was 71.4% (95%CI 58.7-82.1%). Conclusion: In spontaneously breathing preoperative noncardiac surgical patients, preoperatively detected IVCCI≧50% can predict postinduction hypotension with high specificity but low sensitivity. Despite moderate performance, IVCCI is an easy, noninvasive and attractive option to identify patients at risk and should be explored further.

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Section: Discussionsupporting

confidence: 86%

Role of inferior vena cava collapsibility index in the prediction of hypotension associated with general anesthesia: an observational study

Szabó

Bozó

Darvas

et al. 2019

Preprint

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“…In this study, people whose fluid therapy was guided by CVCCI evaluation had a 35% relative risk reduction in the development of hypotension. 22 In a recent meta-analysis evaluating the CVCCI capability to predict fluid responsiveness in spontaneously breathing human patients, CVCCI showed moderate accuracy with a pooled sensitivity of 0.80 (95% CI, 0.68 to 0.89) and a pooled specificity of 0.79 (95% CI, 0.60 to 0.90). In patients undergoing mechanical ventilation, the pooled sensitivity and specificity were 0.79 (95% CI, 0.67 to 0.86) and 0.70 (95% CI, 0.63 to 0.76), respectively.…”

Section: Discussionmentioning

confidence: 99%

Caudal vena cava collapsibility index as a tool to predict fluid responsiveness in dogs

Donati¹,

Guevara²,

Ardiles

et al. 2020

J Vet Emergen Crit Care

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“…Mačiulienė et al failed to detect the prognostical role of IVCCI [17], while another recent trial reported an IVCCI based fluid replacement strategy as a useful tool to reduce the incidence of hypotension [18].…”

Section: Discussionmentioning

confidence: 99%

Role of inferior vena cava collapsibility index in the prediction of hypotension associated to general anesthesia: an observational study

Szabó

Bozó

Darvas

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: Intraoperative hypotension increases 30-day mortality, risk of myocardial injury and acute renal failure. Patients having inadequate volume reserve before induction of anesthesia are highly exposed. Identification of subclinical hypovolemia is therefore crucial. Ultrasonographic measurement of inferior vena cava collapsibility index (IVCCI) is able to detect volume responsiveness in circulatory shock. Ther is a lack of current evidence whether preoperative application could identify high risk patients for hypotension associated to general anesthesia. Methods: 102 patients (conforming ASA status I-III, without significant cardiac pathology) undergoing elective abdominal surgery under general anesthesia with standardized propofol induction were recruited to this prospective observational study. IVCCI was measured under spontaneous breathing. A collapsing (IVCCI≧50%) (CI+) and a non-collapsing (CI-) group were formed. Immediate postinductional changes in systolic and mean blood pressure were compared. Performance of IVCCI’s 50% cut-off as a diagnostic tool for predicting hypotension (systolic pressure below 90 mmHg or >30% drop from baseline) was evaluated by ROC curve analysis. Results: A total of 83 patients were evaluated, 20 in the CI+ and 63 in the CI- group. Mean decrease of systolic pressure in CI- group was 35.8±18.1 mmHg compared to 53.8±15.3 mmHg of CI+ patients (P=0.0001). Relative decrease in systolic pressures differed significantly as well: CI- patients had a mean of 24.7±11.3% while this was 36.4±9.1% in CI+ group (P<0.0001). Relative mean arterial pressure change medians were 24.2% (IQR 17.2%-30.2%) and 34.1% (IQR 23.2%-43.0%) respectively (P=0.0029). The ROC-curve analysis for IVCCI showed an AUC of 64.8% (95%CI 52.1-77.5%). Selected 50% level of IVCCI had a sensitivity of only 45.5% (95%CI 28.1-63.7%) but specificity was high: 90.0% (78.2-96.7%). Positive predictive value revealed as 75.0% (95%CI 50.9-91.3%) and negative predictive value was 71.4% (95%CI 58.7-82.1%). Conclusion: Preoperatively detected IVCCI≧50% is a moderately useful test to identify patients susceptible to postinductional hypotension. However, due to its low sensitivity, it has a low value in excluding it. Keywords: Anesthesia, hypotension, propofol, vena cava, inferior, echocardiography

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Prevention of arterial hypotension after spinal anaesthesia using vena cava ultrasound to guide fluid management

Abstract: www.clinicaltrials.gov - NCT02271477.

Cited by 59 publications

References 35 publications

Role of inferior vena cava collapsibility index in the prediction of hypotension associated with general anesthesia: an observational study

Role of inferior vena cava collapsibility index in the prediction of hypotension associated with general anesthesia: an observational study

Caudal vena cava collapsibility index as a tool to predict fluid responsiveness in dogs

Role of inferior vena cava collapsibility index in the prediction of hypotension associated to general anesthesia: an observational study

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