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

IF 1.3 Q3 ANESTHESIOLOGY Saudi Journal of Anaesthesia Pub Date : 2024-10-01 Epub Date: 2024-10-02 DOI:10.4103/sja.sja_222_24
Gaurav Chaudhary, Sadik Mohammed, Ghansham Biyani, Swati Chhabra, Pradeep K Bhatia, Manoj Kamal, Rakesh Kumar, Kamlesh Kumari
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Abstract

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 < 0.001). The time required for acquiring US images was significantly less for SCV compared to IVC during both quiet and deep breathing (P < 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.

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锁骨下静脉与下腔静脉塌陷指数在预测诱导后低血压方面的诊断准确性:一项观察性研究。
背景:全身麻醉(GA)诱导后常见低血压。已有研究通过超声(US)测量下腔静脉(IVC)的塌陷指数(CI)来预测诱导后低血压。由于比较锁骨下静脉(SCV)与 IVC-CI 诊断准确性的数据有限,我们进行了这项观察性研究:方法:共招募了 132 名计划在 GA 下进行择期手术的成人患者。在安静和深呼吸时记录 SCV 和 IVC 最大和最小直径的三次 US 测量值,并计算三次测量值的平均值。CI 的计算公式为(dmax - dmin) × 100/dmax。随后,无论 SCV 和 IVC 测量结果如何,均采用标准技术给予 GA。记录给药和剂量。血流动力学参数在基线时收集,然后在最初的 20 分钟内每分钟收集一次。主要目的是比较 SCV-CI 和 IVC-CI 在预测安静呼吸时诱发后低血压的诊断准确性。次要目标是比较深呼吸时的诊断准确性,并找出安静呼吸和深呼吸时 IVC-CI 与 SC-CI 之间的相关性、低血压发生率以及获取 US 图像所需的时间:结果:57 名患者在诱导后出现低血压。在安静呼吸时,SCV-CI ≥10%对诱发后低血压的预测灵敏度为68%,特异度为56%(曲线下面积[AUC][95% 置信区间{CI}]为0.659 [0.56-0.75]; P = 0.002),而IVC-CI ≥34%对诱发后低血压的预测灵敏度为70%,特异度为59%(曲线下面积[AUC][95% 置信区间{CI}]为0.672 [0.58-0.76]; P = 0.001)。在深呼吸过程中,SCV-CI 和 IVC-CI 都具有中等准确性(P = 0.001)。皮尔逊相关性显示 SCV-CI 和 IVC-CI 之间存在显著的正相关,安静呼吸时相关系数 (r) 为 0.313,深呼吸时相关系数 (r) 为 0.379(P < 0.001)。在安静呼吸和深呼吸时,SCV 获取 US 图像所需的时间均明显少于 IVC(P < 0.001):结论:在预测诱导后低血压方面,SCV-CI 和 IVC-CI 都具有良好的可比诊断准确性。我们还发现 SCV-CI 和 IVC-CI 之间存在明显的正相关性。与 IVC 相比,SCV 的 US 扫描获取图像所需的时间更短。
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来源期刊
CiteScore
1.90
自引率
8.30%
发文量
141
审稿时长
36 weeks
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