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

2019 ◽  
Author(s):  
Marcell Szabó ◽  
Anna Bozó ◽  
Katalin Darvas ◽  
Alexandra Horváth ◽  
Zsolt Dániel Iványi
Keyword(s):  
Observational Study ◽  
Inferior Vena Cava ◽  
General Anesthesia ◽  
Roc Curve ◽  
Inferior Vena ◽  
Vena Cava ◽  
Systolic Pressure ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Collapsibility Index

Abstract 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.

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

2019 ◽  
Author(s):  
Marcell Szabó ◽  
Anna Bozó ◽  
Katalin Darvas ◽  
Alexandra Horváth ◽  
Zsolt Dániel Iványi
Keyword(s):  
Observational Study ◽  
Inferior Vena Cava ◽  
General Anesthesia ◽  
Roc Curve ◽  
Inferior Vena ◽  
Vena Cava ◽  
Systolic Pressure ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Collapsibility Index

Abstract 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.

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

2019 ◽  
Author(s):  
Marcell Szabó ◽  
Anna Bozó ◽  
Katalin Darvas ◽  
Alexandra Horváth ◽  
Zsolt Dániel Iványi
Keyword(s):  
Observational Study ◽  
Inferior Vena Cava ◽  
General Anesthesia ◽  
Roc Curve ◽  
Inferior Vena ◽  
Vena Cava ◽  
Systolic Pressure ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Collapsibility Index

Abstract 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.

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

2019 ◽  
Author(s):  
Marcell Szabó ◽  
Anna Bozó ◽  
Katalin Darvas ◽  
Alexandra Horváth ◽  
Zsolt Dániel Iványi
Keyword(s):  
Observational Study ◽  
Inferior Vena Cava ◽  
General Anesthesia ◽  
Roc Curve ◽  
Inferior Vena ◽  
Vena Cava ◽  
Systolic Pressure ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Collapsibility Index

Abstract 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

scholarly journals Measurement of Inferior Ven Cava Collapsibility Index and Its Correlation to Central Venous Pressure in Adult Critically Ill Patients a Prospective Observational Study

2020 ◽  
Vol 5 (1) ◽  
Keyword(s):  
Inferior Vena Cava ◽  
Central Venous Pressure ◽  
Inferior Vena ◽  
Venous Pressure ◽  
Vena Cava ◽  
Volume Status ◽  
P Value ◽  
Central Venous ◽  
Collapsibility Index ◽  
Status Assessment

Fluid therapy is an essential component part management of critically ill patients. Proper estimation of the amount of needed fluids is of great importance due to the well-established adverse effects of marked negative and positive fluids balance. Central venous pressure has been widely used by ICU physicians for volume status assessment. Several methods have been postulated for volume status assessment, among which is the inferior vena cava collapsibility index. As the inferior vena cava is a thin-walled capacitance vessel that adjusts to the body’s volume status by changing its diameter depending on the total body fluid volume. Giving the fact that bed-side ultrasonographic measurement of inferior vena cava diameters is an available, non-invasive, reproducible and quiet easy-to-learn technique, it can provide a safe and quiet reliable replacement of central venous pressure measurement for assessment of volume status assessment. The aim of this study was to find statistical correlation between central venous pressure and caval index, as a step towards validating the above mentioned replacement. 86 critically ill patients from ICU population were enrolled. Simultaneous measurements of central venous pressure and inferior vena cava collapsibility index were observed and recorded on four sessions. Patients were also grouped based on their mode of ventilation and central venous pressure values in order to compare the strength of correlation between various populations. The results showed that Inferior vena cava collapsibility index has significant inverse correlation with CVP value (r= -85, p value ˂0.001 at 95% CI) and it better correlated with mean arterial blood pressure and lactate clearance as compared to central venous pressure. However it correlated better with CVP in spontaneously breathing patients (r= -0.86, p value ˂0.001) than in mechanically ventilated patients (r= -0.84, p value ˂0.001). Inferior vena cava collapsibility index has shown to correlate better with CVP value in lower values (˂ 10 cmH2O) (r= -0.8, p value ˂0.001) than in higher values (≥ 10 cmH2O) (r= -0.6, p value ˂0.001). In addition, an inferior vena caval collapsibility index cut-off value of 29% was shown to discriminate between CVP values ˂10 cmH2O and values ≥10 cmH2O with high Sensitivity (88.6%) and specificity (80.4%). In conclusion, inferior vena cava collapsibility index has a strong inverse relationship with central venous pressure which is more pronounced at low central venous pressure values. Point-of-care ultrasonographically-measured inferior vena cava collapsibility index is very likely to be a good alternative to central venous pressure measurement with a high degree of precision and reproducibility. However, Wide scale studies are needed to validate its use in different patient populations.

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