Collapsibility Index Research Articles

Application of ultrasound-guided inferior vena cava collapsibility measurement in volume assessment for patients undergoing single-shot spinal anesthesia in total hip arthroplasty.

To explore the value of ultrasound in volume assessment during the perioperative period of single-shot spinal anesthesia for total hip arthroplasty. A total of 100 patients undergoing elective surgery under spinal anesthesia at our hospital from January 2022 to January 2024 were selected. Transthoracic echocardiography was used to measure the diameter of the abdominal aorta (Ao) before anesthesia (T1), 10 minutes after anesthesia (T2), and 30 minutes after anesthesia (T3). The inferior vena cava collapsibility index (IVC-CI) and the ratio of IVCe to Ao (IVCe/Ao) were calculated. A volume load test was performed 10 minutes after anesthesia. Based on the increase in stroke volume (ΔSV) after the volume load test, patients were divided into a volume-responsive group (ΔSV ≥ 15%) and a volume-nonresponsive group (ΔSV < 15%). The reliability of inferior vena cava parameters in predicting hypotension after spinal anesthesia and the value in predicting volume responsiveness postanesthesia were evaluated using ROC curves. A total of 100 patients were enrolled, 18 were withdrawn, and a total of 82 patients were included. After the volume load test, the parameters of the volume response group and the volume nonresponse group were basically consistent, and the difference was not statistically significant (P > .05). The SV of volume reaction group was significantly higher than that of volume no reaction group (P < .05). The incidence of hypotension in the volume response group was higher than that in the non-volume response group (51.28% vs 11.63%, χ2 = 15.174, P < .01). The AUC for volume reactivity prediction using IVCe, IVCi, IVC-CI, and IVCe/Ao were 0.62, 0.71, 0.70, and 0.72, respectively. IVCi, IVC-CI, and IVCe/Ao were significant predictors of volume reactivity (P < .05). The AUC predicting persistent hypotension after spinal anesthesia using IVCe, IVCi, IVC-CI, and IVCe/Ao were 0.78, 0.79, 0.70, and 0.84, respectively. IVCe, IVCi, IVC-CI, and IVCe/Ao can predict volume reactivity before anesthesia. IVCi, IVC-CI, and IVCe/Ao predicted persistent hypotension in patients with spinal anesthesia after anesthesia, and IVCe/Ao showed the best predictive effect. Thus, IVCe/Ao is a reliable parameter for predicting persistent hypotension and assessing volumetric reactivity.

Efficacy of the inferior vena cava collapsibility index in predicting anaesthesia-induced hypotension in elderly patients undergoing hip arthroplasty

The inferior vena cava collapsibility index (IVCCI) has been used to predict fluid responsiveness. This study aimed to evaluate the accuracy of the perioperative IVCCI to predict postinduction hypotension (PIH) under general anaesthesia (GA) combined with lumbar plexus sacral plexus block (LSPB) in elderly patients undergoing hip arthroplasty. A total of forty patients aged over 65 years were recruited for this prospective observational study. The diameters of the inferior vena cava (IVC), common iliac vein (CIV) and IVCCI were measured at baseline and 15 min post-LSPB. PIH was defined as a systolic blood pressure less than 90 mmHg or a ≥ 30% drop from baseline; patients were divided into hypotensive and nonhypotensive groups. The primary objective of this study was to evaluate the ability of the IVCCI to predict PIH via receiver operating characteristic (ROC) analysis. The secondary objective was to observe the change in CIV diameter. Eighteen patients (45%) developed PIH during GA. No statistically significant differences in baseline or post-LSPB IVCCI were detected between hypotensive and nonhypotensive patients (p > 0.05), whereas a significant expansion of the CIV (0.83 cm to 1.10 cm) was observed 15 min post-LSPB in all patients (p < 0.0001). According to the ROC curve analysis, the IVCCI cannot accurately predict severe PIH: the area under the ROC curve for the IVCCI was 0.54 (95% confidence interval: 0.35–0.72, P = 0.69). Thus, the IVCCI is not an effective predictor of PIH during GA combined with LSPB in elderly patients undergoing hip arthroplasty. Additionally, significant expansion of the CIV was observed 15 min after LSPB, indicating sympathetic blockade of the unilateral lower extremity.

Echocardiographic Assessment of Central Venous Pressure using Inferior Vena Cava Indices: An Estimate Guide for Right Atrial Pressure

Purpose: To assess the correlation between inferior vena cava echocardiographic indices and central venous pressure, right atrial pressure and thus to practice, assessment of inferior vena cava, as a guide for the status of right side of the heart. Materials and Methods: In this descriptive cross-sectional study, a total of (60) patients (males and females) with their age ranging between (18–80) years were admitted to the respiratory care unit. Echocardiographic assessment of inferior vena cava hemodynamics (IVC expiratory, IVC inspiratory diameters and IVC collapsibility index) were carried out. In addition to the standard echocardiography examination, right heart function measurements (Tricuspid Annular Plane Systolic Excursion and right atrial area), in spontaneously and mechanically ventilated, patients were done. Findings: Both IVCe and IVCi diameters showed strong negative correlation with collapsibility index, (r= -0.920 for IVCe and r= -0.964 for IVCi) (P&lt;0.001). There was a positive correlation between TAPSE and IVC-CI (r=0.857, P&lt;0.001). Moreover, RA area was negatively correlated with collapsibility index (r = -0.892, P &lt;0.001). IVC-CI in mechanically ventilated patients (40.11± 1.782) compared to spontaneous breathing (48.91± 1.811) (P &lt;0.001) Implications to Theory, Practice and Policy: There was a linear relationship of IVC collapsibility index with TAPSE but an inverse relation with RA area. Evaluation of IVC diameter and its collapsibility index was an easy and non-invasive method to estimate CVP and RAP and so evaluate right heart performance of critically ill patients. Its use is more helpful in patients who are spontaneously breathing than those who are mechanically ventilated. The study tried to find an estimate predictor of right atrial pressure.

Evaluation of lateral sagittal infraclavicular block according to inferior vena cava collapsibility index (VCI-CI): An observational study.

Depending on the total amount of fluid, changes occur in the amount of fluid in the peripheral area. The aim of this study was to observe the differences caused by hemodynamic changes after lateral sagittal infraclavicular block (LS-ICB) according to the inferior vena cava collapsibility index (VCI-CI). In this prospective, observational study (Clinical Trial Number: NCT05968105), patients undergoing elective hand and wrist surgery with LS-ICB were classified according to VCI-CI, with Group 1 defined as inferior vena cava (VCI) diameter < 1.5 cm and VCI-CI > 50% and Group 2 defined as VCI diameter > 1.5 cm and VCI-CI < 50%. Groups were compared for demographic characteristics, defined durations, rescue analgesics, and complications. Continuous hemodynamic parameters and pulsed wave Doppler were evaluated within groups. Demographic characteristics and time periods were comparable between the groups. Hemodynamic parameters and pulsed wave Doppler measurements showed no significant differences. However, while Group 1 remained consistent, Group 2 exhibited differences in axillary artery diastolic diameter and axillary artery contractility index. A significant statistical difference was observed in Group 1 for the perfusion index at 30 minutes and postoperatively, whereas Group 2 remained consistent. The dosage and number of patients requiring rescue analgesics were similar across both groups, and no complications were reported. Blood flow increased after LS-ICB without a corresponding increase in axillary artery diameter. Group 1 showed a tendency toward a lower perfusion index in the postoperative period.

Inferior vena cava collapsibility index for predicting hypotension after spinal anesthesia in patients undergoing total knee arthroplasty.

This study aimed to identify risk factors associated with hypotension in patients undergoing total knee arthroplasty (TKA) under spinal anesthesia. Atotal of 200 patients (50-75years of age) who underwent elective TKA under spinal anesthesia between October 2023 and January 2024 were enrolled. Patients were divided into two groups (hypotensive and nonhypotensive) depending on the occurrence of postspinal anesthesia hypotension (PSAH). Patient characteristics (age, sex, body mass index, and medical history), blood pressure, heart rate, and ultrasound data before anesthesia were documented. Multivariate logistic regression models were used to determine risk factors for hypotension after spinal anesthesia. Furthermore, anomogram was constructed according to independent predictive factors. The area under the curve (AUC) and calibration curves were employed to assess the performance of the nomogram. In total, 175 patients were analyzed and 79(45.1%) developed PSAH. Logistic regression analysis revealed that variability of the inferior vena cava (odds ratio, OR, 1.147; 95% confidence interval, CI: 1.090-1.207; p < 0.001) and systolic arterial blood pressure (SABP, OR 1.078; 95% CI: 1.043-1.115; p < 0.001) were independent risk factors for PSAH. Receiver operating characteristic (ROC) curve analysis showed that the AUC of the inferior vena cava collapsibility index (IVCCI) and SABP alone were 0.806 and 0.701, respectively, while the AUC of both combined was 0.841. Specifically, an IVCCI of > 37.5% and systolic arterial blood pressure of > 157 mm Hg were considered threshold values. Furthermore, we found that the combination had abetter predictive value with higher AUC value, sensitivity, and specificity than the index alone. The nomogram model and calibration curves demonstrated the satisfactory predictive performance of the model. Elevated preoperative systolic arterial blood pressure and ahigher IVCCI were identified as independent risk factors for hypotension in patients receiving spinal anesthesia, which may help guide personalized treatment.

Diagnostic accuracy of subclavian vein versus inferior vena cava collapsibility index for predicting postinduction hypotension: An observational study

Background: Hypotension following induction of general anesthesia (GA) is commonly observed. Ultrasound (US) measurement of collapsibility index (CI) of the inferior vena cava (IVC) for predicting postinduction hypotension has been studied. As there is limited data available comparing the diagnostic accuracy of subclavian vein (SCV) versus IVC-CI, we performed this observational study. Methods: A total of 132 adult patients scheduled for elective surgery under GA were enrolled. US measurements of three readings of maximum and minimum diameters of SCV and IVC were recorded during both quiet and deep breathing, and the mean of three values was calculated. CI was derived using the formula: (dmax – dmin) × 100/dmax. Subsequently, GA was administered using standard technique, irrespective of the findings of SCV and IVC measurements. The administered drugs and dosage were recorded. Hemodynamic parameters were collected at baseline and then at every minute for the first 20 min. The primary objective was to compare the diagnostic accuracies of SCV-CI and IVC-CI for prediction of postinduction hypotension during quiet breathing. The secondary objectives were to compare the diagnostic accuracies during deep breathing and find the correlation between IVC-CI and SC-CI during quiet and deep breathing, incidence of hypotension, and time required to acquire US images. Results: Fifty-seven patients developed postinduction hypotension. During quiet breathing, SCV-CI ≥10% had a sensitivity of 68% and specificity of 56% (area under curve [AUC] [95% confidence interval {CI}] of 0.659 [0.56–0.75]; P = 0.002), while IVC-CI ≥34% had a sensitivity of 70% and specificity of 59% (AUC [95% CI] of 0.672 [0.58–0.76]; P = 0.001) for prediction of postinduction hypotension. During deep breathing, both SCV-CI and IVC-CI had moderate accuracy (P = 0.001 for both). Pearson’s correlation showed a significant positive correlation between SCV-CI and IVC-CI with a correlation coefficient (r) of 0.313 during quiet breathing and 0.379 during deep breathing (P &lt; 0.001). The time required for acquiring US images was significantly less for SCV compared to IVC during both quiet and deep breathing (P &lt; 0.001 for both). Conclusion: Both SCV-CI and IVC-CI were found to have good and comparable diagnostic accuracy for the prediction of postinduction hypotension. We also found a significant positive correlation between SCV-CI and IVC-CI. In comparison to IVC, US scanning of SCV took lesser time to acquire the images.

Assessment of superior vena cava diameter and collapsibility index in liver transplantation: a prospective observational study

BackgroundSuperior Vena Cava (SVC) diameter and collapsibility index, dynamic measures of fluid responsiveness, have been successfully utilized as echocardiographic indices for fluid responsiveness in ventilated septic patients. Whether these measurements are correlated with Central Venous Pressure (CVP) measurements in liver transplant patients is unknown. We sought to assess the correlation of maximum and minimum SVC diameter and SVC collapsibility index measurements obtained intraoperatively by Transesophageal Echocardiography (TEE) with those of simultaneously recorded CVP measurements obtained through a right atrial port of a pulmonary artery catheter. The secondary aim of the study was to assess the correlation between SVC measurements and simultaneously obtained thermodilution cardiac index measurements. MethodsSingle center prospective observational trial of patients with end stage liver disease undergoing liver transplantation in an academic tertiary care center. ResultsThe minimum SVC exhibited a mild significant correlation with CVP as did the maximum SVC. The correlation between the SVC collapsibility index and CVP was not significantly different from zero. In our secondary analysis, the correlation between minimum SVC diameter and cardiac index was determined to be weak but non-zero as was the correlation between the maximum SVC diameter and cardiac index. The correlation between SVC collapsibility index and cardiac index was not different from zero. ConclusionWhile statistically significant, the weak clinical correlation of intraoperative SVC measurements obtained by TEE make them unsuitable as a replacement for central venous pressure or thermodilution cardiac index measurements in liver transplant recipients.

Inferior vena cava collapsibility index and trauma severity in elderly fall injuries.

Falls are a serious cause of morbidity and mortality among older people. One of the underlying causes of falls is dehydration. Therefore, ultrasonography has become an essential tool for evaluating volume status in the emergency department. However, the effect of volume status on falls in older people has not been evaluated before. The aim of this study was to determine the relationship between the inferior vena cava collapsibility index and the injury severity score in older patients who presented with fall-related injuries to the emergency department. A total of 66 patients were included in the study. The injury severity score was used as the trauma severity score, and the Edmonton Frail Scale was used as the frailty scale. Volume status was evaluated with inferior vena cava collapsibility index. The primary outcome measure was defined as the correlation between inferior vena cava collapsibility index and injury severity score. Secondary outcome measures were defined as the effect of inferior vena cava collapsibility index and injury severity score on hospitalization and mortality. There was no significant correlation between injury severity score and inferior vena cava collapsibility index (p=0.342). Neither inferior vena cava collapsibility index nor injury severity score was an indicator of the mortality of these patients. However, injury severity score was an indicator of hospitalization. The mean Edmonton Frail Scale score was an indicator of mortality among older people who experienced falls (p=0.002). Inferior vena cava collapsibility index cannot be used to predict trauma severity in older patients who have experienced falls admitted to the emergency department.

Fluid responsiveness in acute respiratory distress syndrome patients: a post hoc analysis of the HEMOPRED study.

Optimal fluid management in patients with acute respiratory distress syndrome (ARDS) is challenging due to risks associated with both circulatory failure and fluid overload. The performance of dynamic indices to predict fluid responsiveness (FR) in ARDS patients is uncertain. This post hoc analysis of the HEMOPRED study compared the performance of dynamic indices in mechanically ventilated patients with shock, with and without ARDS, to predict FR, defined as an increase in aortic velocity time integral (VTI) > 10% after passive leg raising (PLR). Among 540 patients, 117 (22%) had ARDS and were ventilated with a median tidal volume of 7.6 mL/kg [6.9-8.4] and a median positive end-expiratory pressure of 7 cmH2O [5-9]. FR was observed in 45 ARDS patients (39% vs 44% in non-ARDS patients, p = 0.384). Reliability of dynamic indices to predict FR remained consistent in ARDS patients, though with different thresholds. Collapsibility index of the superior vena cava (ΔSVC) showed the best predictive performance in both ARDS (area under the curve [AUC] = 0.763 [0.659-0.868]) and non-ARDS (AUC = 0.750 [0.698-0.802]) patients. A right to left ventricle end-diastolic area ratio > 0.8 or paradoxical septal motion were strongly linked to the absence of FR (> 80% specificity). FR was not associated with intensive care unit (ICU) mortality (47% vs. 46%, p = 1). However, hypovolemia, defined as an aortic VTI increase > 32% during PLR (median increase in patients with a partial SVC collapse) was independently associated with ICU mortality (odds ratio [OR] = 1.355 [1.077-1.705], p = 0.011), as well as pulse pressure variation (OR = 1.014 [1.001-1.026], p = 0.034). Performance of dynamic indices to predict FR appears preserved in ARDS patients, albeit with distinct thresholds. Hypovolemia, indicated by a > 32% increase in aortic VTI during PLR, rather than FR, was associated with ICU mortality in this population.

Primerjava ultrazvočnega merjenja premera spodnje votle vene in merjenja sestave telesa z metodo bioelektrične impedance za oceno tekočinskega stanja pri novorojenčkih

Background: Neonatal medical conditions often disrupt the physiological processes that regulate fluid balance, so assessing fluid status in sick neonates is important for clinical management. In clinical practice we use clinical signs, which, however, on their own, do not provide a reliable assessment of fluid status. We aimed to compare two methods: i) diameters and collapsibility index of vena cava inferior (VCI) measured by ultrasonography and ii) analysis of body composition by bioelectrical impedance (BIA) and to evaluate their relation to changes in body mass. Methods: In a cohort-prospective clinical trial we included 27 neonates aged 1–7 days with various pathologies. Ultrasound measurements of VCI transversely and longitudinally, measurements of body composition by BIA and measurements of body mass were performed in each subject at least three times with an interval of 24–72 hours. Simultaneous measurements of the same subject were then analysed and evaluated. Results: The average proportion of total body water (TBW) decreased in the first days after birth, from 80.3% (Day 1) to 73.1% (Day 8) (p = 0.006). The decrease in the average proportion of extracellular water (ECW) in the first days after birth was not statistically significant. The association between ECW and body mass over time was statistically significant (p &lt; 0.001). The association between transversely measured large VCI diameter during inspiration, body mass, and ECW was statistically significant (p = 0.024). No statistically significant association with ECW or body mass was proven for the other ultrasound-measured variables. Conclusions: By measuring body composition with BIA, we confirmed the reduction of the average proportions of TBW after birth and the association between body mass, ECW, and transversely measured maximal diameter of VCI during inspiration. BIA is an appropriate method for monitoring fluid status in a newborn. Additional research on a larger number of subjects is needed to define the significance of VCI measurements for assessing fluid status.

Thermo-mechanical response of sand-silt mixtures

The thermo-mechanical response under undrained conditions is crucial in evaluating the mechanical behaviors of sand-silt mixtures. A series of consolidated undrained triaxial shear tests were conducted to investigate the mechanical response of sand-silt mixtures with different fines contents, temperatures, and initial mean effective stresses. The results showed that the volume shrinkage was observed in all specimens during heating. The amplitudes of volume shrinkage were dependent on the fines content and initial mean effective stress. Moreover, the fines content and temperature significantly influence the peak strength, flow behavior, stress ratio at the undrained instability state, and collapsibility index. Furthermore, a unified critical state line has been established in the compression plane for both clean sand and binary mixture under different temperatures and fines contents. It is reliable and suitable to use the equivalent skeleton void ratio to illustrate the thermo-mechanical response of sand-silt mixtures under undrained conditions.

Effects of nano-clay on the geotechnical properties of gypseous soil

Abstract Gypseous soils suffer from sudden settlement when subjected to water flow due to dissolving of gypsum salts, so all structures constructed on gypseous soil undergo significant deformations due to the soil’s ability to collapse. Around the world, specifically in the arid and semi-arid regions gypseous soils are mostly found also, and can be found in the west desert of Iraq and even in the southern regions, amounting about between 30 and 35% of the country’s total area. There are several techniques to improve the geotechnical properties of collapsible soils, but one of the most recent techniques is using the nano technology. Five different proportions of nano-clay (NC) were incorporated into a gypseous soil containing 80% gypsum in order to enhance its chemical and geotechnical characteristics (1, 2, 3, 4, and 5%). The tests findings (chemical, physical, and mechanical tests) demonstrated that the addition of nano-clay to gypseous soil has a significant impact on the geotechnical properties of soil where it leads to decrease the gypsum content of soil, pH value, maximium dry density, specific gravity, and collapse index. On the other hand, the utilized of nano clay material causes to increase shear strength parameters (c and φ), optimum water content and liquid limit. Adding 4% of nano-clay results in a significant decrease of 53% in the collapse index and an increase of 311% in soil cohesion and 30% in the angle of internal friction.

IVC collapsibility indices in assessment of volume overload in neonatal cardiac patients

BackgroundFluid overload is associated with increased morbidity and mortality in critically ill patients. An accurate assessment of fluid status in neonatal cardiac pediatric patients is required for assessment of fluid overload. Estimation of fluid status using different Doppler parameters may be helpful in determination of fluid status.PurposeTo evaluate difference in fluid status in neonates with and without congenital heart diseases. To detect sensitivity of Doppler Ultrasound in early determination of fluid status. To compare between different parameters (IVC diameter, IVCCI, and IVC/AO ratio) between cardiac and healthy neonates.MethodsTransabdominal Doppler parameters of 25 full-term newborns with congenital heart diseases and congestive heart failure were compared to 25 post-natal age and sex-matched normal healthy neonates serving as controls. Aortic as well as inspiratory and expiratory inferior vena cava diameters were measured. Subsequently, inferior vena cava collapsibility index (IVCCI) and inferior vena cava-to-aortic ratio (IVC/AO) were calculated.ResultsFluid overload detected by increased IVC diameter (decreased IVCCI and increased IVC/AO ratio) was observed in the cardiac compared to the control group. There was positive correlation between the fluid volume and the IVC diameter and IVC/AO ratio and negative correlation with the IVC collapsibility indices.ConclusionsFluid overload with increased IVC diameter and lack of IVC collapsibility were observed in neonates with congenital heart diseases and congestive heart failure compared with those hemodynamically stable controls. We recommend the use of IVC diameter, IVCCI, and IVC/AO ratio as rapid, easy and sensitive parameters in assessing volume status.

Does Pelvic Floor Muscle Exercise Change the Hemodynamic Responses of the Inferior Vena Cava in Pregnant Women? A Prospective-Controlled Study.

This study was aimed at exploring the immediate impacts of pelvic floor muscle exercises (PFMEs) on various maternal physiological parameters in pregnant women. The study included a total of 52 women, 26 pregnant (Pregnant group: 28.04±6.01 years; 26.83±3.81 kg/m2) and 26 nonpregnant (Control group: 29.42±5.73 years; 25.41±3.03 kg/m2) individuals. All women received PFME as follows: PFME was performed for 5 min (6-s holding contraction, 10 s of relaxation, 3 rapid PFM contractions). Evaluations were conducted before, immediately after, and 5 min post-exercise, with measurements including inferior vena cava (IVC) diameters and pulsatility index, blood pressure, oxygen saturation, and heart rates. Two-way analysis of variance was performed for group and time comparisons in repeated measurements. In both groups, the IVC collapsibility index values were lower 5 min after exercise, although this decrease, although clinically significant, did not reach statistical significance (p= 0.057). Post-exercise systolic blood pressure significantly decreased in both groups, whereas diastolic blood pressure decreased significantly in the pregnant group (p= 0.001, p= 0.023). The study found no statistically significant changes in the collapsibility index of the IVC after PFME but observed a clinically suggestive decrease. The clinical decrease in the collapsibility index can be interpreted as PFME in the supine position increasing venous return. Additionally, PFME was found not to alter maternal and fetal heart rates but contributed to the decrease in maternal systolic and diastolic blood pressure. Our study supports the view that the acute effects of PFME neither induce fetal stress nor pose maternal risks.

Assessment of Ultrasonographic Measurement of Inferior Vena Cava Collapsibility Index in the Prediction of Hypotension Associated with Tourniquet Release in Total Knee Replacement Surgeries under Spinal Anesthesia

Abstract This was a Prospective, observational study conducted on 60 patients with Total Knee Replacement (TKR); to characterize the collapsibility index of the IVC as a potential screening tool to identify patients who are candidate for hypotensive events after tourniquet release in TKR in an otherwise hemodynamically stable population. We found that; the mean age of all patients was (57 ± 5.6) years. Regarding gender of the patients, (58.3%) of patients were females; while (41.7%) were males. Regarding basic clinical data; the mean BMI of all patients was (25.7 ± 2.5); with (60%) of patients had DM, and (56.7%) had HTN. Regarding ASA class, (3.3%) had class I, (73.3%) had class II, and (23.3%) had class III. Regarding Baseline hemodynamic data; the average MAP was (104.6 ± 6) mmHg, the average RR was (10.5 ± 1.3) breath/min, and the average HR was (74.75 ± 7) beat/min. Regarding Data before tourniquet release; the average MAP was (102.3 ± 7.5) mmHg, the average RR was (10.7 ± 1.2) breath/min, and the average HR was (75.3 ± 6.5) beat/min, with average IVC-CI of (48.4 ± 7.7). Regarding Data 15-m after tourniquet release; the average MAP was (93.1 ± 9.3) mmHg, the average RR was (10.7 ± 1.4) breath/min, and the average HR was (76.45 ± 6.6) beat/min, with average IVC-CI of (51 ± 8.4). Regarding final outcome, (11.7%) of patients suffered Hypotension (PTRH). The 60 TKR patients were classified according to outcomes into 2 independent groups: group A IVCCI &amp;gt;55,5% (12 patients) and group B IVCCI &amp;lt;55,5% (48 patients). Regarding comparative study between the 2 groups as regards demographic data; no statistically significant differences were found except for ASA physical status of patients where group A had patients in ASA I class and most of its patients are ASA II while group B had no patients in ASA I class and a quarter of its patients were ASA III. Regarding comparative study between the 2 groups as regards hemodynamic and ultrasonographic data; no statistically different results were noted between groups in baseline readings. Results recorded before tourniquet release showed that IVC during inspiration reading was statistically lower while IVC collapsibility index was statistically higher in Group A when compared with group B . Results recorded 15 min after tourniquet release showed that IVC during inspiration reading was statistically lower while IVC collapsibility index was statistically higher in Group A when compared with group B, the IVC-CI before tourniquet release was not correlated with percent reduction in systolic blood pressure after tourniquet release in both groups with high (Group A) or low IVC-CI (Group B). Comparing patients who developed hypotension versus patients who did not, the 60 TKR patients were classified into hypotensive (7 patients) and normotensive (53 patients) groups. No statistically significant differences were found between hypotensive versus normotensive patients concerning demographic data and data recorded before tourniquet release. Baseline data showed significantly higher respiratory rate in hypotensive patients. Data recorded 15 min after tourniquet release showed statistically lower SBP, DBP and MAP, significantly higher HR and significantly lower IVC during inspiration and expiration in patients who developed hypotension. We studied different factors that may be included before tourniquet release that may predict the degree of PTRH by using ROC-curve analysis. IVC-CI before tourniquet release and BMI failed to be predictive factors for the occurrence of PTRH, while respiratory and heart rates before tourniquet release significantly predict the occurrence of PTRH. Performing multiple regression analysis using forward method showed that the increase in RR had an independent effect on increasing the probability of PTRH occurrence; with significant statistical difference (p &amp;lt; 0.039). Conclusion IVC-CI before tourniquet release is not a predictor for PTRH in patients undergoing TKR under spinal anesthesia.

Correlation between Central Venous Pressure and Inferior Vena Cava Diameter for Fluid Assessment in Patients with Chronic Obstructive Pulmonary Disease

Abstract Background Chronic obstructive pulmonary disease (COPD) is now the third leading cause of death globally.3 Although COPD primarily affects the lungs, it is now also recognized as a complex multi-component disease characterized by chronic systemic inflammation that frequently coexists with other conditions known as co morbidities. Objective To determine the correlation between central venous pressure (CVP) and the IVC collapsibility index for estimating the fluid status in COPD patients. Patients and Methods After obtaining the approval of the Ain Shams University Ethical Committee and written informed consent, 20 patients aged 21 - 60 years of either sex, admitted in the ICU of Ain Shams teaching hospitals who have a functioning central venous catheter inserted for any clinical indication, were involved in this correlational study. CVP measurements were taken with the patient in the supine position from the zero point and the middle line. Results The current study showed that there was no statically significant correlation Between CVP (cmH2O) and Heart Rate (beat /min), MABP (mmHg), IVCd max (cm) and IVC CI % at Baseline, After PLR test, After Bolus fluid administration, After 3 hours and After 6 hours. Conclusion The measurement of the IVC diameter has a good correlation with CVP and useful for assessment of the volume status. The measurement of the IVC by ultrasonography may be an important additional evaluation of critically ill patients.

Inferior vena cava ultrasound to predict hypotension after general anesthesia induction: a systematic review and meta-analysis of observational studies.

Hypotension after induction of general anesthesia is common and is associated with significant adverse events. Identification of patients at high risk can inform the use of preoperative mitigation strategies. We conducted a systematic review and meta-analysis to assess the diagnostic accuracy of the inferior vena cava collapsibility index (IVC-CI) and maximal diameter (dIVCmax) in predicting postinduction hypotension and to identify their predictive performance across different threshold ranges. We searched MEDLINE, PubMed®, and Embase from inception to March 2023 for prospective observational studies exploring the performance of IVC-CI and dIVCmax in predicting postinduction hypotension in adults presenting for elective surgery under general anesthesia. We excluded studies reporting on IVC parameters predicting postinduction hypotension in the obstetric patient population or exclusively in patients with obesity. Trials screening and data extraction were conducted independently. We performed meta-analyses to identify the performance of IVC parameters in predicting postinduction hypotension, followed by subgroup analyses that sought the IVC-CI range with the highest hierarchical summary receiver-operating characteristic area under the curve (HSROC-AUC). We used a bivariate random effects model to calculate summary estimates. We evaluated study quality using Newcastle-Ottawa scores and certainty of evidence using the GRADE framework. We included 14 studies involving 1,166 patients. Pooled sensitivity and specificity of the IVC-CI to predict postinduction hypotension was 0.68 (95% confidence interval [CI], 0.55 to 0.79; coverage probability, 0.91) and 0.78 (95% CI, 0.69 to 0.85; coverage probability, 0.9), respectively, with an HSROC-AUC of 0.80 (95% CI, 0.68 to 0.85, high quality of evidence). An IVC-CI threshold range of 40-45% had an HSROC-AUC of 0.86 (95% CI, 0.69 to 0.93, high quality of evidence). Preoperative IVC-CI is a strong predictor of postinduction hypotension. We recommend that future studies use an IVC-CI threshold of 40-45% (low certainty of evidence). Future studies are needed to establish whether ultrasound-guided preoperative optimization improves outcomes in high-risk patients. PROSPERO ( CRD42022316140 ); first submitted 10 March 2022.

Internal Jugular Vein Collapsibility Index versus Inferior Vena Cava Collapsibility Index Guided Preloading for Prevention of Spinal Anesthesia Induced Hypotension During LSCS: An Interventional Study

Background and Aims: Goal directed fluid therapy (GDFT) in parturients helps to prevent spinal anesthesia induced hypotension (SAIH) and volume overload. This interventional study compared the inferior vena cava collapsibility index (IVCCI) and the internal jugular vein collapsibility index (IJVCI) guided preloading for prevention of SAIH during lower segment ceserean section (LSCS) in terms of the incidence of SAIH as the primary outcome and the total amount of fluid, mean dose of the vasopressor, the number of boluses of vasopressor required, and the incidence of intra-operative complications as secondary outcomes. Methodology: A total of 144 full-term parturients aged 20–40 years with American society of anaesthesiologists (ASA) grade II, height (140–165 cms), weight (40–70 kgs), those who were fluid responders, and those who had a window period of 1 hour before surgery under spinal anesthesia (SA) undergoing LSCS were allocated into two groups (n = 72): group IJV and group IVC. Ultrasonography (USG) guided Internal jugular vein (IJV) and Inferior vena cava (IVC) collapsibility index (CI) was recorded an hour before spinal anesthesia (SA) as per the groups assigned and preloaded accordingly. After SA, the incidence of SAIH, the requirement of vasopressor, and fluid were recorded, and side effects were managed. Results: In group IVC, the incidence of SAIH (36.84%), mean dose (3.51 ± 5.02 µg), and mean boluses (0.44 ± 0.63) of norepinephrine required to manage hypotension were significantly lower than in group IJV, and the mean goal directed fluid administered before LSCS (504.46 ± 181.48 ml) and overall mean total fluid (1104.39 ± 160.99 ml) administered were significantly higher than in group IJV. Except for shivering, the incidence of all other complications was significantly lower in group IVC (p &lt; 0.05). Conclusion: Both IVCCI and IJVCI guided preloading are effective in combating SAIH during LSCS, but IVCCI is comparatively better than IJVCI for CI guided preloading.

Combined Lung Ultrasound, Inferior Vena Cava Collapsibility Index and Routine Echocardiography in Detecting and Identifying Type of Shock

Combined Lung Ultrasound, Inferior Vena Cava Collapsibility Index and Routine Echocardiography in Detecting and Identifying Type of Shock

The Role of Ultrasound Guided Internal Jugular Collapsibility Index in Assessment of Fluid Responsiveness in Sepsis: Review Article

The Role of Ultrasound Guided Internal Jugular Collapsibility Index in Assessment of Fluid Responsiveness in Sepsis: Review Article