Acute and Critical Care

Original Articles

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

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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

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

Gastroenterology
The diagnostic accuracy of ultrasonography over manual aspiration for gastric reserve volume estimation in critically ill patients: Rahul Sharma, Ravi Kant Dogra, Jyoti Pathania, Arti Sharma; Acute Crit Care. 2023;38(1):134-141. Published online February 22, 2023; DOI: https://doi.org/10.4266/acc.2022.00955

6,151 View
190 Download
5 Web of Science
6 Crossref

Abstract PDF

Background
Although gastric reserve volume (GRV) is a surrogate marker of gastrointestinal dysfunction and feeding intolerance, there is ambiguity in its estimation due to problems associated with its measurement. Introduction of point-of-care ultrasound as a tool for anesthetists kindled interest in its use for GRV estimation.
Methods
In this prospective observational study, we recruited 57 critically ill patients and analyzed 586 samples of GRV obtained by both ultrasonography (USG) and manual aspiration.
Results
The analysis showed that USG-guided GRV was significantly correlated (r=0.788, P<0.001) and in positive agreement with manual aspiration based on Bland-Altman plot, with a mean difference of 8.50±14.84 (95% confidence interval, 7.389–9.798). The upper and lower limits of agreement were 37.7 and –20.5, respectively, within the ±1.96 standard deviation (P<0.001). The respective sensitivity and positive predictive value, specificity and negative predictive value, and area under the curve of USG for feeding intolerance were 66.67%, 98.15%, and 0.82%, with 96.49% diagnostic accuracy.
Conclusions
Ultrasonographic estimation of GRV was positively, significantly correlated and in agreement with the manual aspiration method and estimated feeding intolerance earlier. Routine use of gastric USG could avoid clinical situations where feeding status is unclear and there is high risk of aspiration and could become a standard practice of critical care.

Citations

Citations to this article as recorded by

Assessing gastrointestinal system dysfunction in intensive care
Kaspar F. Bachmann, Varsha M. Asrani, Annika Reintam Blaser
Current Opinion in Critical Care.2025; 31(2): 172. CrossRef
Interoperator reproducibility of ultrasound assessment of gastric residual volume in critically Ill patients
Mahmoud M.A. Mohamed, Aya M.A.A. Galeel, Mohamed A. Megahed, Dina H.E. Zidan
Research and Opinion in Anesthesia & Intensive Care.2025; 12(3): 263. CrossRef
Correlación de volumen residual gástrico medido y ultrasonido gástrico para identificar intolerancia gástrica en pacientes neurocríticos con nutrición enteral en la unidad de cuidados intensivos
Mauricio Pérez-Macías, Roxana Vázquez-Ramírez, Marcela Pinedo-Lechuga
Medicina Crítica.2024; 38(2): 102. CrossRef
Is pre-extubation fasting in ICU justified? Insights from a prospective observational study using gastric ultrasound
Mohd Saif Khan, Barun Ram, Amit Kumar, Kamel Bousselmi, Priyesh Kumar, Dumini Soren, Priyanka Shrivastava, Naveen Kumar
Trends in Anaesthesia and Critical Care.2024; 58: 101497. CrossRef
Early initiation of gastric tube feeding: ultrasound assessment. A prospective interventional study
Islam M. Elbardan, Ahmed A. Alla Ossman, Nada El Kayal, Assem A. ElRazek Abd-Rabih
Research and Opinion in Anesthesia & Intensive Care.2024; 11(4): 270. CrossRef
Gastrointestinal function in critically ill patients
Annika Reintam Blaser, Kaspar F. Bachmann, Adam M. Deane
Current Opinion in Clinical Nutrition & Metabolic Care.2023; 26(5): 463. CrossRef

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