Collapsibility Index Research Articles

Inferior Vena Cava Collapsibility Index Versus Passive Leg Raise To Assess Fluid Responsiveness in Non-Intubated Septic Patients - A Prospective Observational Study

Inferior Vena Cava Collapsibility Index Versus Passive Leg Raise To Assess Fluid Responsiveness in Non-Intubated Septic Patients - A Prospective Observational Study

Evaluation of an artificial intelligence-based system for echocardiographic estimation of right atrial pressure

Current noninvasive estimation of right atrial pressure (RAP) by inferior vena cava (IVC) measurement during echocardiography may have significant inter-rater variability due to different levels of observers’ experience. Therefore, there is a need to develop new approaches to decrease the variability of IVC analysis and RAP estimation. This study aims to develop a fully automated artificial intelligence (AI)-based system for automated IVC analysis and RAP estimation. We presented a multi-stage AI system to identify the IVC view, select good quality images, delineate the IVC region and quantify its thickness, enabling temporal tracking of its diameter and collapsibility changes. The automated system was trained and tested on expert manual IVC and RAP reference measurements obtained from 255 patients during routine clinical workflow. The performance was evaluated using Pearson correlation and Bland-Altman analysis for IVC values, as well as macro accuracy and chi-square test for RAP values. Our results show an excellent agreement (r=0.96) between automatically computed versus manually measured IVC values, and Bland-Altman analysis showed a small bias of -\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$-$$\\end{document}0.33 mm. Further, there is an excellent agreement ((p<0.01\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$(p<0.01$$\\end{document}) between automatically estimated versus manually derived RAP values with a macro accuracy of 0.85. The proposed AI-based system accurately quantified IVC diameter, collapsibility index, both are used for RAP estimation. This automated system could serve as a paradigm to perform IVC analysis in routine echocardiography and support various cardiac diagnostic applications.

Subclavian Vein Collapsibility as a Predictor of Fluid Responsiveness in Spontaneously Breathing Hypotensive Patients

Background and Objective: Volume replacement remains the cornerstone of resuscitation in critically ill patients. This study explored the ability of the subclavian vein collapsibility index to predict fluid responsiveness. Methods: In this prospective observational study conducted in the Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, sonographic evaluation of inferior vena cava and the right subclavian vein was carried out at three time points for hypotensive patients admitted to the emergency department. The study population was divided into two groups: responders and non-responders, based on a ≥ 15 % increase in stroke volume following fluid bolus. Results: Among 45 recruited patients, 33 patients were responders. The area under the ROC curve for SCV CI at baseline to predict fluid responsiveness was 0.745 (95% confidence interval: 0.549 – 0.941; p = 0.014). An SCV-CI of 46 % predicted fluid responsiveness in a hypotensive patient in terms of change in stroke volume by 15% following fluid bolus with a sensitivity of 87.88 % (95 % confidence interval: 71.80% to 96.60%) and specificity of 66.67 % (95 % confidence interval: 34.89% to 90.08%). Spearman’s correlation coefficient between IVC CI and SCV CI was 0.59 (p &lt; 0.001, n = 135). Conclusion: The results of the study demonstrated that right subclavian vein respiratory variation has the ability to predict fluid responsiveness in a spontaneously breathing patient in circulatory shock and correlates with the inferior vena cava collapsibility index. The subclavian vein can be an alternative to the inferior vena cava in predicting fluid responsiveness in spontaneously breathing patients.

Assessing the Efficacy of Inferior Vena Cava Collapsibility Index for Predicting Hypotension after Central Neuraxial Block: A Systematic Review and Meta-Analysis.

The use of ultrasonography to predict spinal-induced hypotension (SIH) has gained significant attention. This diagnostic meta-analysis aimed to investigate the reliability of the inferior vena cava collapsibility index (IVCCI) in predicting SIH in patients undergoing various surgeries. Databases, including Embase, Cochrane Library, Medline, and Google Scholar, were screened until 28 July 2023, yielding 12 studies with 1076 patients (age range: 25.6-79 years) undergoing cesarean section (CS) (n = 4) or non-CS surgeries (n = 8). Patients with SIH had a significantly higher IVCCI than those without SIH (mean difference: 11.12%, 95% confidence interval (CI): 7.83-14.41). The pooled incidence rate of SIH was 40.5%. IVCCI demonstrated satisfactory overall diagnostic reliability (sensitivity, 77%; specificity, 82%). The pooled area under the curve (AUC) was 0.85, indicating its high capability to differentiate patients at risk of PSH. The Fagan nomogram plot demonstrated a positive likelihood ratio (PLR) of 4 and a negative likelihood ratio (NLR) of 0.28. The results underscore the robustness and discriminative ability of IVCCI as a predictive tool for SIH. Nevertheless, future investigations should focus on assessing its applicability to high-risk patients and exploring the potential enhancement in patient safety through its incorporation into clinical practice.

Ultrasound Guided Preoperative Assessment of Inferior Vena Cava Collapsibility Index in Prediction of Intraoperative Hypotension in Patients Undergoing Laparoscopic Cholecystectomy Surgery under General Anesthesia

Abstract Background Laparoscopic surgery aims to minimize trauma of the interventional process but still achieve a satisfactory therapeutic results. It is commonly performed because of various advantages such as reduced postoperative pain, faster recovery and more rapid return to normal activities, shorter hospital stay, and reduced postoperative pulmonary complications. Aim of the Work In this study we aim to evaluate effectiveness of preoperative IVC ultrasonography (IVC CI) in prediction of hypotension (mean arterial pressure &amp;gt;60 mmHg) which develops following intraabdomenal gas insufflation, and in determining hypovolemia occurring in patients undergoing laparoscopic cholecystectomy surgery under general anesthesia. Patients and Methods This study was a prospective observational study conducted on 50 patients inside the operative theatre of El demerdash hospital after ethical committee approval. Results There was a statistically significant negative correlation between IVC CI and Change of MBP (mmHg) After induction from baseline with; while Change of MBP (mmHg) After insufflation of abdomen from baseline was of negative correlation but insignificant as there was no dehydrated patients among this study group preoperatively according to our measurements and for ethical purposes we considered that if there was any patient needed hydration preoperative according to preoperative assessment of IVC-CI should be managed before surgery in order not to have intraoperative hypotension which can affect his wellness intra and postoperative, also all the patients were ASA I/II with no critical illness affect volemic status and usage of deprevan, fentanyl and atracurium during induction which can cause hypotension post induction. Conclusion In this study there was a statistically significant negative correlation between IVC CI and Change of MBP (mmHg) After induction from baseline; while Change of MBP (mmHg) After insufflation of abdomen from baseline is of negative correlation but insignificant. We believe that IVC ultrasonography may be helpful in prediction of preoperative hypovolemia in patients who underwent laparoscopic cholecystectomy.

Point-of-Care Ultrasonography for the Assessment of Dehydration in Children: A Systematic Review.

Accurate estimation of the degree of dehydration remains a diagnostic challenge. The primary objective was to systematically review the literature on the role of ultrasound in assessment of the degree of dehydration in children. Data sources included Ovid MEDLINE, Web of Science Core Collection, Current Index to Nursing and Allied Health Literature, Cochrane Library, ClinicalTrials.gov , and Trip Pro Database. Two independent reviewers used screening protocol to include articles on assessment of dehydration in children with the use of point-of-care ultrasonography (POCUS). The level of evidence was assessed in accordance with the "The Oxford 2011 Levels of Evidence." The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to evaluate risk of bias. We identified 108 studies, and 8 studies met our inclusion criteria. All studies were prospective cohort studies (level of evidence, 3-4). The authors of 5 studies used difference between ill weight and weight after rehydration as the reference standard for dehydration, and the authors of 3 studies used clinical dehydration scale. Two studies from the United States showed acceptable areas under the curve for inferior vena cava to aorta (IVC/Ao) diameter ratio at 0.72 and 0.73 for prediction of significant dehydration (>5% weight loss). The IVC/Ao ratio with cut-off at 0.8 had sensitivity of 67% and 86% and specificity of 71% and 56% for prediction of significant dehydration. Studies from the resource-limited settings were more heterogeneous. One study with acceptable risk of biases reported poor sensitivity (67%) and specificity (49%) of Ao/IVC ratio with cut-off of 2.0 for predicting severe dehydration (>9% weight loss) with area under the curve at 0.6. Three studies showed increase in IVC diameter with fluid resuscitation with mean change in IVC diameter by 30% in children with significant dehydration (>5% weight loss) and by 22% without significant dehydration (<5% weight loss). Metaanalysis was not completed due to high heterogeneity. This study showed that the quantity and quality of research on the application of POCUS for the assessment of dehydration in children is limited. There is no criterion standard for assessing the degree of dehydration and no universal definition of the degree of dehydration. Thus, more methodologically rigorous studies are required. Current systematic review does not support the routine use of US to determine the severity of dehydration in children. Despite these limitations, the use of POCUS in children with dehydration demonstrates potential. Given the clear increase in IVC size with rehydration, repeated IVC US scans may be helpful in guiding fluid resuscitation in children with dehydration. From different proposed US parameters, IVC/Ao ratio has better diagnostic accuracy in detecting significant dehydration than Ao/IVC ratio and IVC collapsibility index. Despite low to moderate diagnostic performance, US still showed better assessment of dehydration than physician gestalt and World Health Organization score.

Evaluation of the Effect of Three Different Tidal Volumes on Internal Jugular Vein Collapsibility Index in Hypovolemic Mechanically-Ventilated Patients Before and After Fluid Therapy

Evaluation of the Effect of Three Different Tidal Volumes on Internal Jugular Vein Collapsibility Index in Hypovolemic Mechanically-Ventilated Patients Before and After Fluid Therapy

Follow-up of perfusion index and inferior vena cava collapsibility index in fluid therapy in prerenal acute renal failure

IntroductionAcute renal failure (ARF), which may occur as a result of hypovolemia, is frequently diagnosed in emergency departments. It is essential to determine these patients' volume status and fluid requirement. The aim of this study was to examine the change in the inferior vena cava (IVC) collapsibility index and perfusion index (PI) in order to evaluate fluid deficit, volume status, and response to fluid therapy in patients with prerenal ARF who presented with signs of hypovolemia. Materials and methodsThe study sample included 104 patients diagnosed with prerenal ARF due to hypovolemia in our emergency department. After obtaining informed consent from the patients, intravenous (IV) fluid therapy (20 cc/kg IV infusion of 0.9% sodium chloride solution for 30 min) was initiated. The PI and IVC collapsibility index were measured before and after the treatment. ResultsOf the patients included in this study, 56.7% were women. The mean age was 76.06 years. Of the patients, 46.2% had a history of multiple diseases. Avoidant/restrictive food intake disorder was the most common complaint (28.8%). The mean PI of the patients was 2.20 at admission, which increased to 3.27 after treatment. The mean IVC collapsibility index was 38.39 at admission, which decreased to 29.36 after treatment. There was a significant and negative correlation between the PI and IVC collapsibility index of the patients. ConclusionsEarly diagnosis and treatment of ARF in emergency departments are critical. Serial measurements of the IVC collapsibility index and PI are helpful in monitoring patients’ response to fluid therapy.

Role of Vena Cava Inferior Ultrasound in Volume Assesment

Regulation of body fluid volume is a key concern for physicians in intensive care units. In intensive care, it is most important to determine the intracellular fluid status because it directly affects the volume status of the patient. Ultrasonography appears to be a useful tool for the assessment of body fluid status. The gold standard for measuring central venous pressure (CVP) is a central venous catheter. Vena cava inferior ultrasound (US-VCI) has been proposed as the non-invasive technique of choice for CVP assessment due to its wide availability, low costs, and ease of use. While a depleted IVC is often observed in hypovolemic patients, typically the IVC is dilated in a hypervolemic condition with a less pronounced or null respiratory collapse in the appropriate clinical context. respiratory variability in VCI diameteris known as the caval index (collapsibility index=VCImaxVCImin /VCImax) and is considered to reflect the intravascular volume state. According to the current updated American and European guidelines, an IVC diameter ≤2.1 cm and collapsibility &gt;50% during inspiration suggest a RAP between 0–5 mm Hg while a diameter &gt;2.1 cm with &lt;50% inspiratory collapse indicates a high RAP of 10–20 mmHg. Primarily because of complicated pathophysiological mechanisms, ultrasound measurement of VCI should not be used as the only parameter in the assessment of volemic status.

Accuracy of preoperative evaluation of inferior vena cava collapsibility index and caval aorta index for prediction of hypotension after induction of general anesthesia: a prospective observational study

Background &amp; Objective: Post general anesthesia induction hypotension (PGAH) is not a rare event. Almost every induction agent has been incriminated to a variable extent. Preoperative ultrasound assessment of Inferior Vena Cava Collapsibility Index (IVCCI) has been investigated for predicting hypotension with mixed results. Inferior vena cava to aorta diameter index (IVC/Ao) hasn’t been studied before as a predictor for PGAH. We studied the comparative accuracy of preoperative IVCC and IVC/Ao index for PGAH prediction.&#x0D; Methodology: This observational prospective blinded study involved 102 participants undergoing different surgeries under general anesthesia. Preoperative ultrasound assessment of IVCCI and IVC/Ao index was done. Mean arterial pressure (MAP) was assessed 6 times; before induction, 1 min and 3 min after induction and 1, 5 and 10 min after endotracheal intubation. The area under the receiver operating characteristic curve (AUROC) was calculated for the ability of IVCC and IVC/Ao index to predict PGAH. Stepwise, backward logistic regression model was constructed to detect and quantify the predictive factors of PGAH.&#x0D; Results: A total of 80 (78.43%) patients developed PGAH. ROC curve analysis for PGAH prediction demonstrated better diagnostic accuracy for IVC/Ao index than IVCCI, as the AUC of both were 0.666 (P &lt; 0.017) and 0.487 (P = 0.852) respectively. IVC/Ao index cutoff value was 0.852&#x0D; Conclusions: Inferior vena cava collapsibility index and inferior vena cava to aorta diameter ratio (IVC/Ao) index are both reliable indicators of post general anesthesia induction hypotension. IVC/Ao index is a more accurate and reliable indicator than inferior vena cava collapsibility index.&#x0D; Abbreviations: CVP: Central Venous Pressure; IVCCI: Inferior Vena Cava Collapsibility Index; IVC/Ao: Inferior Vena Cava to Aorta Diameter Index; IVCD: Inferior Vena Cava Diameter; PAOP: Pulmonary Artery Occlusion Pressure; PGAH: Post General Anesthesia Induction Hypotension&#x0D; Key words: Hypotension; General Anesthesia; Ultrasound; IVCCI; Aorta&#x0D; Citation: Omar H, Moamen A, Abdelhamid BM, Rady A, Farouk I. Accuracy of preoperative evaluation of inferior vena cava collapsibility index and caval aorta index for prediction of hypotension after induction of general anesthesia: a prospective observational study. Anaesth. pain intensive care 2023;27(4):449−455; DOI: 10.35975/apic.v27i4.2255&#x0D; Received: October 12, 2022; Reviewed: March 03, 2023; Accepted: May 20, 2023

Inferior vena cava ultrasound and other techniques for assessment of intravascular and extravascular volume: an update.

Goals of volume management are to accurately assess intravascular and extravascular volume and predict response to volume administration, vasopressor support or volume removal. Data are reviewed that support the following: (i)Dynamic parameters reliably guide volume administration and may improve clinical outcomes compared with static parameters, but some are invasive or only validated with mechanical ventilation without spontaneous breathing. (ii)Ultrasound visualization of inferior vena cava (IVC) diameter variations with respiration reliably assesses intravascular volume and predicts volume responsiveness. (iii)Although physiology of IVC respiratory variations differs with mechanical ventilation and spontaneous breathing, the IVC collapsibility index (CI) and distensibility index are interconvertible. (iv)Prediction of volume responsiveness by IVC CI is comparable for mechanical ventilation and spontaneous breathing patients. (v)Respiratory variations of subclavian/proximal axillary and internal jugular veins by ultrasound are alternative sites, with comparable reliability. (vi)Data support clinical applicability of IVC CI to predict hypotension with anesthesia, guide ultrafiltration goals, predict dry weight, predict intra-dialytic hypotension and assess acute decompensated heart failure. (vii)IVC ultrasound may complement ultrasound of heart and lungs, and abdominal organs for venous congestion, for assessing and managing volume overload and deresuscitation, renal failure and shock. (viii)IVC ultrasound has limitations including inadequate visualization. Ultrasound data should always be interpreted in clinical context. Additional studies are required to further assess and validate the role of bedside ultrasonography in clinical care.

A preoperative ultrasound-based protocol for optimisation of fluid therapy to prevent early intraoperative hypotension: a randomised controlled study

BackgroundIntraoperative hypotension is a risk factor for postoperative complications. Preoperative dehydration is a major contributor, although it is difficult to estimate its severity. Point-of-care ultrasound offers several potential methods, including measurements of the inferior vena cava. The addition of lung ultrasound may offer a safety limit. We aimed to evaluate whether the implication of an ultrasound-based preoperative fluid therapy protocol can decrease the incidence of early intraoperative hypotension.MethodsRandomised controlled study in a tertiary university department involves elective surgical patients of ASA 2–3 class, scheduled for elective major abdominal surgery under general anaesthesia with intubation. We randomised 40–40 patients; 38–38 were available for analysis. Conventional fluid therapy was ordered on routine preoperative visits. Ultrasound-based protocol evaluated the collapsibility index of inferior vena cava and lung ultrasound profiles. Scans were performed twice: 2 h and 30 min before surgery. A high collapsibility index (≥ 40%) indicated a standardised fluid bolus, while the anterior B-profile of the lung ultrasound contraindicated further fluid. The primary outcome was the incidence of postinduction and early intraoperative (0–10 min) hypotension (MAP < 65 mmHg and/or ≥ 30% of decrease from baseline). Secondary endpoints were postoperative lactate level, urine output and lung ultrasound score at 24 h.ResultsThe absolute criterion of postinduction hypotension was fulfilled in 12 patients in the conventional group (31.6%) and 3 in the ultrasound-based group (7.9%) (p = 0.0246). Based on composite criteria of absolute and/or relative hypotension, we observed 17 (44.7%) and 7 (18.4%) cases, respectively (p = 0.0136). The incidence of early intraoperative hypotension was also lower: HR for absolute hypotension was 2.10 (95% CI 1.00–4.42) in the conventional group (p = 0.0387). Secondary outcome measures were similar in the study groups.ConclusionWe implemented a safe and effective point-of-care ultrasound-based preoperative fluid replacement protocol into perioperative care.Trial registrationThe study was registered to ClinicalTrials.gov on 10/12/2021, registration number: NCT05171608 (registered prospectively on 10/12/2021).

Noninvasive Hemodynamic Profiling of Patients Undergoing Hemodialysis Using a Handheld Ultrasound Device

INTRODUCTION: Accurate determination of volume status for patients with end-stage renal disease is essential in determining ultrafiltration rate during hemodialysis (HD). To complement the current dry weight method, inferior vena cava (IVC) collapsibility, made accessible by point of-care ultrasonography, is considered. This study determined the utility of IVC measurement in estimating the volume status of patients during HD in comparison to clinical parameters. METHODS: A single-center cross-sectional design including 53 HD patients was conducted, with IVC measurements done through the Butterfly iQ ultrasound (Butterfly Network, Burlington, Massachusetts). RESULTS: Most patients were hypervolemic before HD based on weight (94.3%) and IVC collapsibility index (IVC-CI; 75.5%), but only 30% had clinical symptoms. Body weight, maximum IVC diameter, minimum IVC diameter, and indexed IVC size significantly decreased after HD, whereas IVC-CI, blood pressure, and heart rate were unchanged. For the subset of patients with symptoms, absolute values of IVC measures were higher, but did not significantly change after HD, unlike in those without symptoms. For volume classification, there are discrepancies in the classifications based on the different measures, with most improvement seen when weight was used, but which was not reflected in IVC-CI. Change in weight and IVC measures were not significantly correlated. DISCUSSION: This pilot study showed that the current dry weight method provides ultrafiltration rate estimation without causing intradialytic events. However, IVC can be a supplemental parameter to set higher targets and increase volume removal enough to cause intravascular change, especially in symptomatic patients. The incongruencies in classifying volume status suggest that there is no single measure to determine hemodynamic status and that using multiple parameters may provide a more reliable estimate. KEYWORDS: inferior vena cava measurement, volume status in hemodialysis, point-of-care ultrasonography

#2880 ASSESSMENT OF FLUID STATUS BY COMBINATION OF LUNG ULTRASOUND, BIOIMPEDANCE, AND INFERIOR VENA CAVA MEASUREMENT IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Assessment of fluid status in hemodialysis patients (HD) remains a major challenge for nephrologists. Fluid overload is one of the most common modifiable risk factors directly associated with hypertension. The purpose of our study was to investigate whether the combination of three bedside methods-lung ultrasound comets (LUC), multifrequency bioimpedance (MBIS), and inferior vena cava diameter (IVCD) measurement-could provide complementary information to guide the management of HD patients. Method We assessed MBIS, LUC at 28 typical sites, and IVCD in 18 HD patients enrolled in the HD maintenance program. LUC and IVCD measurements were performed three times-before, during, and after HD, MBIS only before and after HD. For MBIS measurement, we used the Body Composition Monitor (Fresenius Medical Care, Bad Homburg, Germany), and for LUC and IVCD, we used an ultrasound machine (Esaote MyLabOmega, Genoa, Italy). Ultrafiltration during HD was not adjusted for LUC, IVCD, and MBIS. Overhydration (OH) was defined as &amp;gt; 2L with MBIS, &amp;gt; 15 LUC, and &amp;lt; 40% collapsibility index (CI) on IVCD. Results The mean age of participants was 61 (IQR, 47-74) years, and thirteen (72.2%) were male. The average dialysis vintage of our patients was 105 months (IQR, 30-155). According to the OH criteria before, during, and after HD, 13 (72%), 2 (11%) patients were overhydrated according to MBIS, 10 (56%), 7 (39%), 3 (17%) patients according to LUC, and 13 (72%), 12 (67%), and 11 (61%) patients according to CI. We found no correlation between systolic blood pressure (BP), diastolic BP, MBIS, LUC, and CI before, during, and after HD, except that systolic BP after HD correlated with MBIS (OH) after HD (r = 0.491; p = 0.039). Using the paired-samples T-test, we found a statistically significant difference between OH before and after HD (p &amp;lt; 0.001), between LUC before and during HD (p = 0.006), between LUC during and after HD (p = 0.002), and between LUC before and after HD (p &amp;lt; 0.001). Using the paired-samples T-test, no statistically significant difference was found between systolic, diastolic BP and CI before, during, and after HD. Conclusion Optimal assessment of fluid status in HD patients remains challenging and, according to our results, may require a combination of LUC and MBIS parameters.

PREOPERATIVE ULTRASOUND-GUIDED INFERIOR VENA CAVA COLLAPSIBILITY INDEX AS A GUIDE TO PREDICT HYPOTENSION FOLLOWING SPINAL ANESTHESIA

Objective: Post-spinal hypotension is a commonly encountered complication following spinal anesthesia. However, there is a dearth of a concrete tool to predict spinal-induced hypotension (SIH) and differentiate the cohort of patients requiring fluid boluses versus vasopressors to correct it. Thus, we aimed to determine the prognostic efficacy of ultrasonographic assessment of inferior vena caval collapsibility index (IVC-CI) to predict hypotension following spinal anesthesia and compare the requirements of crystalloids and Mephentermine among patients with IVC-Collapsibility Index &gt;50% and &lt;50%. Methods: This observational study was conducted in the Department of Anesthesiology, Government Medical College, Kottayam. Preoperative IVC Ultrasonography was performed in 74 patients of ASA Grade 1–2 scheduled for elective surgery under spinal anesthesia and their IVC-CI was determined. Spinal anesthesia procedure protocol was standardized. Mean arterial pressure, intravenous fluids, and mephentermine requirements were documented in both IVC-CI groups. Results: There was no significant difference in the demographics or pre-operative vital signs between the two groups. Significant hypotension was seen in 51.4% of patients. 97% of patients with IVC-CI&gt;50% had significant hypotension, p=0.000. IVCCI&gt;50% is 97.2% specific and 84.2% sensitive in predicting SIH with a positive predictive value of 96.97% and negative predictive value of 85.37%. Significantly, high requirement of intravenous fluids and mephentermine was noted among IVC-CI&gt;50% group, p=0.000 and 0.026, respectively. Conclusion: USG-guided IVC-CI is an easy to perform, non-invasive, time-efficient, and readily available technique to assess fluid responsiveness. Patients with IVC-CI&gt;50% are more likely to develop SIH. Furthermore, the requirement of vasopressors and IV fluids increases with IVC-CI&gt;50%. USG-guided IVC-CI is a reliable predictor of SIH.

Integrated ultrasonographic approach to evaluate fluid responsiveness in critically ill patients

In patients with acute circulatory failure, we tested the feasibility of the evaluation of the fluid-responsiveness (FR) by a combined approach with echocardiography and lung ultrasound. We enrolled 113 consecutive patients admitted to the Emergency Department High-Dependency Unit of Careggi University-Hospital from January 2015 to June 2020. We assessed: (1) inferior vena cava collapsibility index (IVCCI); (2) the variation of aortic flow (VTIAo) during the passive leg raising test (PLR); (3) the presence of interstitial syndrome by lung ultrasound. FR was defined as an increase in the VTIAo > 10% during PLR or IVCCI ≥ 40%. FR patients were treated with fluid and those non-FR with diuretics or vasopressors. The therapeutic strategy was reassessed after 12 h. The goal was to maintain the initial strategy. Among 56 FR patients, at lung ultrasound, 15 patients showed basal interstitial syndrome and 4 all-lung involvement. One fluid bolus was given to 51 patients. Among 57 non-FR patients, 26 patients showed interstitial syndrome at lung ultrasound (basal fields in 14, all lungs in 12). We administered diuretics to 21 patients and vasopressors to 4 subjects. We had to change the initial treatment plan in 9% non-FR patients and in 12% FR patients (p = NS). In the first 12 h after the evaluation, non-FR patients received significantly less fluids compared to those FR (1119 ± 410 vs 2010 ± 1254 ml, p < 0.001). The evaluation of the FR based on echocardiography and lung ultrasound was associated with the reduction in fluid administration for non-FR patients compared with those FR.

Correlation of Internal Jugular Vein Collapsibility With Central Venous Pressure in Patients With Liver Cirrhosis.

We aimed to compare internal jugular vein and inferior vena cava ultrasonography as predictors of central venous pressure in cirrhotic patients. We performed ultrasound assessments of the internal jugular vein (IJV) and the inferior vena cava and then invasively measured central venous pressure (CVP). We then compared their correlation with CVP and performed area under the receiver operating characteristic curves to determine which had best sensitivity and specificity. IJV cross-sectional area collapsibility index at 30° correlated better with CVP ( r = -0.56, P < 0.001), and an IJV AP-CI at 30° ≤ 24.8% was better at predicting a CVP ≥8 mm Hg, with 100% sensitivity and 97.1% specificity. Thus, IJV point-of-care ultrasound might be superior than inferior vena cava point-of-care ultrasound as a predictor of CVP in cirrhotic patients.

Efficacy of inferior vena cava collapsibility index and caval aorta index in predicting the incidence of hypotension after spinal anaesthesia- A prospective, blinded, observational study.

Spinal anaesthesia-induced hypotension (SAIH) is a frequent side effect of spinal anaesthesia. SAIH is usually observed in patients with hypovolemia. Ultrasonography has evolved as a non-invasive tool for volume status assessment. This prospective, blinded, observational study was conducted on 75 adult patients who required spinal anaesthesia after receiving ethical approval and registering the study. Ultrasonographic evaluation of the aorta and the inferior vena cava (IVC) was done preoperatively, and the IVC collapsibility index (IVCCI) and caval aorta index were calculated. The incidence of SAIH was recorded. The strength of the association between different parameters and SAIH was calculated. To find out the value of the optimal cut-off for the prediction of SAIH, receiver operating characteristic (ROC) analysis for various ultrasound parameters was done. The bidirectional stepwise selection was utilised for multivariate analysis to choose the single best predictor. SAIH was observed in 36 patients. Among demographic parameters, age, female gender, and height showed a medium correlation. Among ultrasonographic measurements, minimum IVC internal diameter (IVCmin) and IVCCI showed a strong association with SAIH. The best parameter regarding area under the ROC curve (AUC) and diagnostic accuracy was IVCCI (0.828 and 85%, respectively). On multivariate analysis, age (95% CI [1.01, 1.12], P = 0.024) and IVCCI (95% CI [1.05, 1.18], P < 0.001) were significant independent predictors. At a cut-off point of ≥43.5%, IVCCI accurately predicted SAIH (sensitivity 81% and specificity 90%). Preoperative ultrasonographic assessment of IVC to evaluate its collapsibility index is a convenient, cost-effective, and reproducible tool for predicting SAIH.

Prediction of Hypotension During Neuraxial Anesthesia in Patients with Pregnancy-Induced Hypertension Through Subclavian Vein Collapsibility Index

Objective: To explore and evaluate the predictive value of subclavian vein collapsibility index (SCV-CI) on hypotension during neuraxial anesthesia in patients with pregnancy-induced hypertension (PIH). Methods: Pregnant women with PIH who underwent elective cesarean section in our hospital from January to July 2021 were selected as the research subjects. Patients who experienced hypotension during anesthesia were included into the hypotension group, whereas patients who had a normal blood pressure during anesthesia were included in the normotensive group. The SCV-CI was then calculated for three respiratory cycles, the average value was taken as the base value, and the patient was monitored for another 20 minutes. The blood pressure, heart rate, blood oxygen saturation, and SCV-CI of the patients were measured, and the incidence of maternal nausea and vomiting and cord blood gas were recorded. Then, a correlation analysis was conducted on the relationship between subclavian vein collapsibility index and hypotension. A receiver operating characteristic curve was drawn to seek the threshold value of subclavian vein collapsibility index for post-anesthesia hypotension. Results: There was no significant difference in systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) between the two groups before anesthesia (P &gt; 0.05). After anesthesia, the above indexes (SBP, 103.25 ± 12.48 mmHg; DBP, 58.94 ± 7.46 mmHg; and HR, 52.96 ± 6.48 beats/min) were significantly lower than those of the normal blood pressure group, and the difference was statistically significant (P &lt; 0.05). In comparison, the SCV-CI in the hypotension group was 35.82 ± 4.93% greater than that in the normal blood pressure group (23.85 ± 5.27%), and the incidence of nausea and vomiting in the hypotension group (40.0%) was significantly higher than that in the normotensive group (10.53%), and the difference was statistically significant (P &lt; 0.05). The area under the curve of SCV-CI prediction against hypotension in patients with PIH under neuraxial anesthesia was 0.825 (95% CI: 0.762–0.893, P &lt; 0.001), the cut-off value was 25.68%, the predictive sensitivity was 92.68%, and the specificity was 81.24%. Conclusion: SCV-CI has a good predictive value for the occurrence of hypotension in patients with PIH during neuraxial anesthesia.

Role of Internal Jugular Vein Collapsibility Index in Predicting Post-spinal Hypotension in Pregnant Women Undergoing Cesarean Section: A Prospective Observational Study.

Introduction Post-spinal hypotension (PSH) frequently occurs in women undergoing cesarean section. In recent studies, Ultrasound-guided measurements of the internal jugular vein (IJV) have been reported to predict fluid responsiveness. We planned to evaluate the correlation between the internal jugular vein collapsibility index (IJVCI) and PSH in cesarean section patients. Methods Ninety-one parturients who underwent elective lower segment cesarean section with a singleton pregnancy were recruited. Preoperatively, patients were placed in a supine position with a 15-degree left lateral tilt. Maximum (at the end of expiration) and minimum (at the end of inspiration) IJV diameters (mm) and IJVCI were assessed using M-mode imaging during spontaneous and deep breathing. Spinal anaesthesia was performed at the L3-4 or L4-5 level. Systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, respiratory rate, and SpO2 were recorded from baseline till the delivery of the baby. Results Among 91 patients, 40 (45.5%) patients had at least one episode of hypotension. Demographic variables and baseline vitals were comparable between the hypotensive and normotensive groups (p>0.05). In spontaneous and deep breathing, IJV diameter at the end-expiration (IJVdmax), end-inspiration (IJVdmin), and IJVCI amongst both hypotensive and non-hypotensive pregnant women were statistically similar. Receiver Operating Characteristic (ROC) curve analysis showed that during spontaneous breathing, using a cut-off point of 29.5%, IJVCI had a sensitivity and specificity of 70% and 23%, respectively, for predicting PSH; whereas during deep breathing, IJVCI had a sensitivity and specificity of 77% and 27%, respectively, for predicting the same using a cut-off value of 37.5%. Conclusion We conclude that internal jugular vein parameters such as maximum diameter, minimum diameter, and IJVCI during spontaneous and deep breathing cannot be used as reliable predictors of post-spinal hypotension in pregnant patients undergoing elective cesarean section.