Preoperative Ultrasonographic Assessment of Caval-Aortic Index and Inferior Vena Cava Collapsibility Index for Predicting Postinduction Hypotension During General Anesthesia: A Prospective Observational Study.

内容摘要

This study aimed to compare the predictive performance of the inferior vena cava collapsibility index (IVC-CI) and the caval-aortic (IVC:Ao) index for postinduction hypotension. Prospective observational study. Tertiary care university hospital. One hundred adult patients scheduled for elective surgery under general anesthesia. Before anesthetic induction, ultrasonographic measurements of the inferior vena cava and abdominal aorta were obtained in the supine position. The IVC-CI and IVC:Ao index were calculated using standard definitions. Mean arterial pressures were recorded every 2 minutes for 10 minutes following induction of anesthesia. Postinduction hypotension occurred in 68 patients (68%). The IVC:Ao index demonstrated excellent discriminative performance (area under the curve [AUC], 0.971; 95% confidence interval [CI], 0.916-0.994) and significantly outperformed the IVC-CI (AUC, 0.846; 95% CI, 0.760-0.910; p = 0.025). An IVC:Ao index cutoff value &#x2264;1.1 yielded a sensitivity of 94.1% and a specificity of 93.8%, with a narrow gray zone (values yielding both sensitivity and specificity <90%) including 10% of patients, compared with 53% for the IVC-CI. In multivariable analyses, each 0.1-unit decrease in the IVC:Ao index was associated with increased odds of hypotension (odds ratio, 4.95; 95% CI, 2.43-10.09; p < 0.001). Similarly, each 10-point increase in the IVC-CI was independently associated with hypotension (odds ratio, 6.17; 95% CI, 2.66-14.31; p < 0.001). Preoperative ultrasonographic assessment of the IVC:Ao index provides superior predictive performance and a substantially narrower gray zone compared with the IVC-CI for identifying patients at risk of postinduction hypotension.