Acute Crit Care.  2024 Feb;39(1):117-126. 10.4266/acc.2023.00913.

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

• Sharma V
• Sharma A
• Sethi A
• Pathania J

• KMID: 2555230
• DOI: http://doi.org/10.4266/acc.2023.00913

Abstract

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.

Keyword

general surgery; hypotension; inferior vena cava; logistic models; propofol; ultrasonography

Figure

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  Figure 1. Flow diagram for the patient selection ASA: American Society of Anesthesiologists; POCUS: point of care ultrasound; SBP: systolic blood pressure; DBP: diastolic blood pressure.

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  Figure 2. Descriptive statistics of heart rate (A) and mean arterial pressure (B) of study subject.

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  Figure 3. (A) Receiver operating characteristics (ROC) of inferior vena cava collapsibility index (IVC-CI). (B) ROC of left ventricular outflow tract velocity time integral (LVOT-VTI). (C) Comparison of area under the curve (AUC) of IVC-CI and LVOT-VTI. (D) Correlation between IVC-CI and LVOT-VTI. Spearman rank correlation coefficient.

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