The use of preoperative inferior vena cava ultrasound 
to predict anaesthesia-induced hypotension: a systematic review

Chowdhury, Sumit; Datta, P. K.; Maitra, Souvik; Rawat, Dimple; Baidya, Dalim Kumar; Roy, Avishek; Nath, Sayan

doi:10.5114/ait.2023.125310

Cited by 8 publications

(8 citation statements)

References 37 publications

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“…There have been several previous studies attempting to predict SAH using TTE. Although the majority of them utilized inferior vena cava (IVC) diameter collapsibility, there was significant variation in predictability [ 7 , 17 , 18 ]. According to a recent meta-analysis, the maximum and minimum reported sensitivities of the IVC collapsibility index (IVCCI) for predicting SAH were 84.6% and 58.8%, respectively, whereas the maximum and minimum specificities were 93.1% and 23.5%, respectively [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Preoperative echocardiography as a predictor of spinal anesthesia-induced hypotension in older patients with mild left ventricular diastolic dysfunction: a retrospective observational study

Park,

Cho,

Kim

et al. 2024

Anesth Pain Med

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Background: Spinal anesthesia-induced hypotension (SAH) frequently occurs in older patients, many of whom have mild left ventricular (LV) diastolic dysfunction, often asymptomatic at rest. This study investigated the association between preoperative echocardiographic measurements and SAH in older patients with mild LV diastolic dysfunction. Methods: We conducted a retrospective observational study using data from electronic medical records. The patients ≥ 65 years old who underwent spinal anesthesia for urologic surgery between January 2016 and December 2017 and whose preoperative echocardiography within 6 months before surgery revealed grade I LV diastolic dysfunction were recruited. SAH was investigated using the anesthesia records. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed.Results: A total of 163 patients were analyzed. SAH and significant SAH developed in 55 (33.7%) patients. The mitral inflow E velocity was an independent risk factor for SAH (odds ratio [OR], 0.886; 95% confidence interval [CI], 0.845–0.929; P < 0.001). The area under the ROC curve for mitral inflow E velocity to predict SAH was 0.819 (95% CI, 0.752–0.875; P < 0.001). If mitral inflow E velocity was ≤ 60 cm/s, SAH was predicted with a sensitivity of 83.6% and specificity of 70.4%. Conclusions: The preoperative mitral inflow E velocity demonstrated the greatest predictability of SAH in older patients with mild LV diastolic dysfunction. This may assist in identifying patients at high risk of SAH and guiding preventive strategies in the future.

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Section: Discussionmentioning

confidence: 99%

Preoperative echocardiography as a predictor of spinal anesthesia-induced hypotension in older patients with mild left ventricular diastolic dysfunction: a retrospective observational study

Park,

Cho,

Kim

et al. 2024

Anesth Pain Med

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“…Even though there are studies that support the idea IVC ultrasonography is a reliable method when necessary technical and patient-related conditions are provided, current status of IVC ultrasonography in current anesthesia and ICU practice is questionable. 24 , 25 Recent data regarding previous studies have found significant heterogeneity in IVC ultrasonography methods both in ICU and in perioperative patients. 24 , 25 On the other hand, our study can be evaluated as a technical study, which aims to compare technical capability of two different devices for IVCD measurements rather than a clinical study that aims to decide fluid status or responsiveness in medical ICU patients.…”

Section: Discussionmentioning

confidence: 99%

“… 24 , 25 Recent data regarding previous studies have found significant heterogeneity in IVC ultrasonography methods both in ICU and in perioperative patients. 24 , 25 On the other hand, our study can be evaluated as a technical study, which aims to compare technical capability of two different devices for IVCD measurements rather than a clinical study that aims to decide fluid status or responsiveness in medical ICU patients. More randomized controlled studies should be done for understanding the place of PSUDs in daily ICU routine for different clinical conditions in which ultrasonography is capable of evaluating.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Pocket-sized Ultrasound Devices to Evaluate Inferior Vena Cava Diameter and Variability in Critically Ill Patients

Inci,

Gürsel

2024

Indian Journal of Critical Care Medicine

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Purpose By using inferior vena cava (IVC) measurements, clinicians can detect fluid status and responsiveness and find out the etiology of hypotension, acute heart failure, and sepsis easier. Pocket-sized ultrasound devices (PSUD) may take this advantage a few steps further by their lower costs, user-friendly interface, and easily applicable structure. In this study, we aimed to determine the diagnostic value of a PSUD compared with a standard ultrasound device (SD) for the measurement of IVC diameter (IVCD) and its respiratory variability. Materials and methods We measured the inspiratory, expiratory diameters of IVC, and calculated the inferior vena cava collapsibility index (IVCCI). We investigated 42 intensive care unit (ICU) patients. Results There was no difference in inspiratory (PSUD: 1.34 ± 0.67 cm; SD: 1.35 ± 0.68 cm) and expiratory (PSUD: 1.98 ± 0.53 cm; SD: 2.01 ± 0.49 cm) IVCD among measurements with PSUD and SD ( p > 0.05). There was also no difference between IVCCI's measured with PSUD (39 ± 20%) and SD (39 ± 20%) ( p > 0.05). The Bland–Altman analysis revealed that the width of 95% limits of agreement were similar for both devices. There was a good inter-device agreement among PSUD and SD for measurements of IVCD, and there was no difference between IVCCI's measured using both ultrasound devices. Conclusion We support that the idea of a PSUD is as reliable as a SD for IVC measurements. How to cite this article Inci K, Gürsel G. Accuracy of Pocket-sized Ultrasound Devices to Evaluate Inferior Vena Cava Diameter and Variability in Critically Ill Patients. Indian J Crit Care Med 2024;28(4):369–374.

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“…Patients who developed hypotension in the current study had higher IVCCI, and they were older in age. Increasing age can be associated with increased respiratory variability of IVC [ 25 ]. Being at higher risk of dehydration, the older population may have higher IVCCI as a pathophysiologic response rather than just a confounder [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Inferior vena cava collapsibility index as a predictor of hypotension after induction of general anesthesia in hypertensive patients

Fathy,

Wahdan,

Salah

et al. 2023

BMC Anesthesiol

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Background Hypertensive patients are more susceptible to develop hypotension after the induction of general anesthesia (GA), most likely due to hypovolemia. An inferior vena cava collapsibility index (IVCCI) > 40–50% can predict hypotension after the induction of GA in the general population by variable accuracies. The current study aimed to investigate IVCCI% as a predictor of postinduction hypotension in hypertensive patients undergoing noncardiac surgery. Methods Ultrasound IVCCI % was assessed for all controlled hypertensive patients immediately before induction of GA. After induction of GA, patients were diagnosed with postinduction hypotension if their systolic arterial pressure (SAP) dropped by ≥ 30% of the baseline value and/or mean arterial pressure (MAP) dropped to < 65 mmHg up to 15 min after intubation. The receiver operating characteristic (ROC) curve of IVCCI% was compared to patients’ classification either developing hypotension after induction of GA or not as a gold standard. Results Of the 153 patients who completed the study, 62 (40.5%) developed hypotension after the induction of GA, and 91 (59.5%) did not. An IVCCI > 39% predicted the occurrence of postinduction hypotension with high accuracy (84%) (AUC 0.908, P < 0.001). The area of uncertainty (by gray zone analysis) of IVCCI lies at values from 39 to 45%. This gray zone included 21 patients (13.7% of all patients). Conclusion An inferior vena cava collapsibility index > 39% before anesthetic induction can be a simple noninvasive reliable predictor of hypotension after the induction of GA for hypertensive patients not treated with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) and undergoing noncardiac surgery. Trial registration This clinical trial was approved by the Institutional Review Board (IRB) at Zagazig University (ZUIRB #9424 dated 03/04/2022), and patients’ informed consent for participation in the study was obtained during the period from May 2022 to May 2023. All study procedures were carried out in accordance with the ethical standards of the Helsinki Declaration of 2013.

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The use of preoperative inferior vena cava ultrasound to predict anaesthesia-induced hypotension: a systematic review

Cited by 8 publications

References 37 publications

Preoperative echocardiography as a predictor of spinal anesthesia-induced hypotension in older patients with mild left ventricular diastolic dysfunction: a retrospective observational study

Preoperative echocardiography as a predictor of spinal anesthesia-induced hypotension in older patients with mild left ventricular diastolic dysfunction: a retrospective observational study

Accuracy of Pocket-sized Ultrasound Devices to Evaluate Inferior Vena Cava Diameter and Variability in Critically Ill Patients

Inferior vena cava collapsibility index as a predictor of hypotension after induction of general anesthesia in hypertensive patients

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