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Original Article
- Cardiology
- Diagnostic accuracy of left ventricular outflow tract velocity time integral versus inferior vena cava collapsibility index in predicting post-induction hypotension during general anesthesia: an observational study
- Vibhuti Sharma, Arti Sharma, Arvind Sethi, Jyoti Pathania
- Acute Crit Care. 2024;39(1):117-126. Published online February 23, 2024
- DOI: https://doi.org/10.4266/acc.2023.00913
- 8,327 View
- 256 Download
- 8 Web of Science
- 8 Crossref
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Abstract
PDF - Background
Point of care ultrasound (POCUS) is being explored for dynamic measurements like inferior vena cava collapsibility index (IVC-CI) and left ventricular outflow tract velocity time integral (LVOT-VTI) to guide anesthesiologists in predicting fluid responsiveness in the preoperative period and in treating post-induction hypotension (PIH) with varying accuracy.
Methods
In this prospective, observational study on included 100 adult patients undergoing elective surgery under general anesthesia, the LVOT-VTI and IVC-CI measurements were performed in the preoperative room 15 minutes prior to surgery, and PIH was measured for 20 minutes in the post-induction period.
Results
The incidence of PIH was 24%. The area under the curve, sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of the two techniques at 95% confidence interval was 0.613, 30.4%, 93.3%, 58.3%, 81.4%, 73.6% for IVC-CI and 0.853, 83.3%, 80.3%, 57.1%, 93.8%, 77.4% for LVOT-VTI, respectively. In multivariate analysis, the cutoff value for IVC-CI was >51.5 and for LVOT-VTI it was ≤17.45 for predicting PIH with odd ratio [OR] of 8.491 (P=0.025) for IVCCI and OR of 17.427 (P<0.001) for LVOT. LVOT-VTI assessment was possible in all the patients, while 10% of patients were having poor window for IVC measurements.
Conclusions
We recommend the use of POCUS using LVOT-VTI or IVC-CI to predict PIH, to decrease the morbidity of patients undergoing surgery. Out of these, we recommend LVOT-VTI measurements as it has showed a better diagnostic accuracy (77.4%) with no failure rate. -
Citations
Citations to this article as recorded by
- Diagnostic Accuracy of Ultrasound‐Generated Inferior Vena Cava Collapsibility Index in the Prediction of Post‐Induction Hypotension During General Anaesthesia: A Systematic Review and Meta‐Analysis
Mitchell Kitchin Gordon, Aharon Golod, Renee Rostolis, Tim Outhred, Rebecca Caragata, Raymond Hu
Australasian Journal of Ultrasound in Medicine.2026;[Epub] CrossRef - Left Ventricular Outflow Indices in Chronic Systolic Heart Failure: Thresholds and Prognostic Value
Frank L. Dini, Valentina Barletta, Piercarlo Ballo, Giovanni Cioffi, Nicola Riccardo Pugliese, Andrea Rossi, Gani Bajraktari, Stefano Ghio, Michael Y. Henein
Echocardiography.2025;[Epub] CrossRef - Perioperative Focused Transthoracic Echocardiogram Evaluations for Elderly Hip Fractures: A Narrative Review of Literature and Recommendations
Michael Armaneous, John Bouz, Tiffany Ding, Christopher Baker, Alina Kim, Avoumia Mourkus, Charles Schoepflin, Justin Calvert
A&A Practice.2025; 19(3): e01944. CrossRef - The Relationship Between Age and the Propofol Dose for Anesthesia Induction: A Single-Center Retrospective Study Utilizing Neural Network Model Simulation
Kazuki Nishimura, Kenji Hirata, Fujita Noriaki, Akira Watabe, Yuji Morimoto
Applied Sciences.2025; 15(11): 6052. CrossRef - Perioperative point-of-care ultrasound
Brett J Wakefield, Nakul Kumar, Andrew Shaw
Journal of Translational Critical Care Medicine.2025;[Epub] CrossRef - Preoperative patient risk factors for intraoperative hypotension: a systematic review and meta-analysis
Nils Daum, Daniel Bill, Moritz Thiele, Julian Felber, Dario von Wedel, Claudia Spies, Felix Balzer, Rudolf Mörgeli, Oliver Hunsicker, Anika Müller, Dennis Contag, Anne Pohrt, Annika Bald, Max Kayser, Sascha Treskatsch, Maximilian Markus
Frontiers in Cardiovascular Medicine.2025;[Epub] CrossRef - The Use of the Perfusion Index to Predict Post-Induction Hypotension in Patients Undergoing General Anesthesia: A Systematic Review and Meta-Analysis
Kuo-Chuan Hung, Shu-Wei Liao, Chia-Li Kao, Yen-Ta Huang, Jheng-Yan Wu, Yao-Tsung Lin, Chien-Ming Lin, Chien-Hung Lin, I-Wen Chen
Diagnostics.2024; 14(16): 1769. CrossRef - Where the Postanesthesia Care Unit and Intensive Care Unit Meet
Mary Rose Gaylor, David N. Hager, Kathleen Tyson
Critical Care Clinics.2024; 40(3): 523. CrossRef
- Diagnostic Accuracy of Ultrasound‐Generated Inferior Vena Cava Collapsibility Index in the Prediction of Post‐Induction Hypotension During General Anaesthesia: A Systematic Review and Meta‐Analysis
Case Report
- Management of Pulmonary Thromboembolism with Inferior Vena Cava Filter: A Case Report
- Yeon Jang, Yun Sun Chin, Hyun Suk Jung, Ho Kyung Song
- Korean J Crit Care Med. 2008;23(2):111-114.
- DOI: https://doi.org/10.4266/kjccm.2008.23.2.111
- 3,162 View
- 14 Download
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Abstract
PDF
- We managed a case in which an inferior vena cava filter was inserted for a pulmonary thromboembolism that occurred during general anesthesia. A 71-year-old woman was prepped for reduction of a distal femur fracture and arthroplastic surgery. Her initial vital signs were stable, but the end-tidal CO2 and SaO2 were decreased gradually after application of the tourniquet for surgery. Because of impaired ventricular wall motion and a dilated inferior vena cava on echocardiogram, we suspected a pulmonary thromboembolism. Thus, we inserted an inferior vena cava filter percutaneously under propofol sedation in the Radiology Department. In addition to ventilatory support and hemodynamic management, heparin was administered as anticoagulant therapy postoperatively in the intensive care unit. Multiple thrombi in the pulmonary artery were confirmed on chest CT. On the 4th postoperative day, she was transferred to the general ward without any complications.
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