Preoperative inferior vena cava collapsibility index predicted post-spinal hypotension with highly variable sensitivities ranging from 58.8% to 84.6% and specificities from 23.5% to 93.1%.
Systematic Review
Does preoperative inferior vena cava ultrasound predict hypotension after spinal or general anaesthesia in adult patients?
Current literature on the predictive role of IVCUS for anaesthesia-induced hypotension is highly heterogeneous, precluding definitive clinical conclusions and highlighting the need for standardized definitions and methodologies.
Preoperative ultrasound assessment of inferior vena cava (IVC) diameter and the collapsi-bility index might identify patients with intravascular volume depletion. The purpose of this review was to gather the existing evidence to find out whether preoperative IVC ultrasound (IVCUS) derived parameters can reliably predict hypotension after spinal or general anaesthesia. PubMed was searched to identify research articles that addressed the role of IVC ultrasound in predicting hypotension after spinal and general anaesthesia in adult patients. We included 4 randomized control trials and 17 observational studies in our final review. Among these, 15 studies involved spinal anaesthesia and 6 studies involved general anaesthesia. Heterogeneity with respect to the patient populations under evaluation, definitions used for hypotension after anaesthesia, IVCUS assessment methods, and cut-off values for IVCUS-derived parameters to predict hypotension precluded pooled meta-analysis. The maximum and minimum reported sensitivity of the IVC collapsibility index (IVCCI) for predicting post-spinal hypotension was 84.6% and 58.8% respectively, while the maximum and minimum specificities were 93.1% and 23.5% respectively. For the prediction of hypotension after general anaesthesia induction, the reported ranges of sensitivity and specificity of IVCCI were 86.67% to 45.5% and 94.29% to 77.27%, respectively. Current literature on the predictive role of IVCUS for hypotension after anaesthesia is heterogeneous both in methodology and in results. Standardization of the definition of hypotension under anaesthesia, method of IVCUS assessment, and the cut-offs for IVC diameter and the collapsibility index for prediction of hypotension after anaesthesia are necessary for drawing clinically relevant conclusions.
Chowdhury et al. (Thu,) conducted a systematic review in Anaesthesia-induced hypotension. Preoperative inferior vena cava ultrasound (IVCUS) was evaluated on Prediction of post-spinal or post-induction hypotension using IVC collapsibility index. Preoperative inferior vena cava collapsibility index predicted post-spinal hypotension with highly variable sensitivities ranging from 58.8% to 84.6% and specificities from 23.5% to 93.1%.