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Can the inferior vena cava collapsibility index be useful in predicting hypotension during spinal anaesthesia in a spontaneously breathing patient? A mini fluid challenge.
Acta Med Litu. 2019; 26(1):1-7.AM

Abstract

The study was performed at the Department of Orthopaedics and Traumatology of the Kauno Klinikos Hospital of Lithuanian University of Health Sciences.

Background

Intravascular fluids are empirically administered to prevent hypotension induced by spinal anaesthesia. Ultrasound measurements of the inferior vena cava (IVC) and the IVC collapsibility index (IVC-CI) is a non-invasive method to evaluate the intravascular volume status. The aim of the study was to identify the prognostic value of the IVC collapsibility index in spontaneously breathing patients to predict severe intraoperative hypotension.

Materials and methods

Sixty patients undergoing elective knee arthroplasty under spinal anaesthesia were included in the prospective study. The diameters of IVCex, IVCin, and IVC-CI were measured before and 15 min after spinal anaesthesia when administration of 500 ml of normal saline using infusion pump was finished. The haemodynamic parameters (heart rate, systolic, diastolic, and mean blood pressures, breathing rate) were collected.

Results

Severe arterial hypotension was noticed in 18.3% of the patients. No statistically significant differences were detected between changes in IVCex, IVCin, and IVC-CI comparing hypotensive and non-hypotensive patients at the baseline and after the interventions (p > 0.005). According to receiver operating characteristic (ROC) analysis, IVC-CI is not effective in the prediction of severe hypotension during spinal anaesthesia in spontaneously breathing patients: the area under the ROC curve for IVC-CI was <0.7, p > 0.05.

Conclusions

IVC-CI is not an effective predictor of severe hypotension after induction of spinal anaesthesia followed by normal saline administration in spontaneously breathing patients undergoing elective knee arthroplasty. More trials, including different patient subgroups, will be needed.

Authors+Show Affiliations

Department of Anaesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.Department of Anaesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.Department of Anaesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.Department of Anaesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.Department of Orthopaedics and Traumatology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.Department of Anaesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31281209

Citation

Jaremko, Inna, et al. "Can the Inferior Vena Cava Collapsibility Index Be Useful in Predicting Hypotension During Spinal Anaesthesia in a Spontaneously Breathing Patient? a Mini Fluid Challenge." Acta Medica Lituanica, vol. 26, no. 1, 2019, pp. 1-7.
Jaremko I, Mačiulienė A, Gelmanas A, et al. Can the inferior vena cava collapsibility index be useful in predicting hypotension during spinal anaesthesia in a spontaneously breathing patient? A mini fluid challenge. Acta medica Lituanica. 2019;26(1):1-7.
Jaremko, I., Mačiulienė, A., Gelmanas, A., Baranauskas, T., Tamošiūnas, R., Smailys, A., & Macas, A. (2019). Can the inferior vena cava collapsibility index be useful in predicting hypotension during spinal anaesthesia in a spontaneously breathing patient? A mini fluid challenge. Acta Medica Lituanica, 26(1), 1-7. https://doi.org/10.6001/actamedica.v26i1.3948
Jaremko I, et al. Can the Inferior Vena Cava Collapsibility Index Be Useful in Predicting Hypotension During Spinal Anaesthesia in a Spontaneously Breathing Patient? a Mini Fluid Challenge. Acta medica Lituanica. 2019;26(1):1-7. PubMed PMID: 31281209.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Can the inferior vena cava collapsibility index be useful in predicting hypotension during spinal anaesthesia in a spontaneously breathing patient? A mini fluid challenge. AU - Jaremko,Inna, AU - Mačiulienė,Asta, AU - Gelmanas,Arūnas, AU - Baranauskas,Tautvydas, AU - Tamošiūnas,Ramūnas, AU - Smailys,Alfredas, AU - Macas,Andrius, PY - 2019/7/9/entrez PY - 2019/7/10/pubmed PY - 2019/7/10/medline KW - collapsibility index KW - fluid therapy KW - hypotension KW - inferior vena cava KW - spinal anaesthesia SP - 1 EP - 7 JF - Acta medica Lituanica VL - 26 IS - 1 N2 - : The study was performed at the Department of Orthopaedics and Traumatology of the Kauno Klinikos Hospital of Lithuanian University of Health Sciences. Background: Intravascular fluids are empirically administered to prevent hypotension induced by spinal anaesthesia. Ultrasound measurements of the inferior vena cava (IVC) and the IVC collapsibility index (IVC-CI) is a non-invasive method to evaluate the intravascular volume status. The aim of the study was to identify the prognostic value of the IVC collapsibility index in spontaneously breathing patients to predict severe intraoperative hypotension. Materials and methods: Sixty patients undergoing elective knee arthroplasty under spinal anaesthesia were included in the prospective study. The diameters of IVCex, IVCin, and IVC-CI were measured before and 15 min after spinal anaesthesia when administration of 500 ml of normal saline using infusion pump was finished. The haemodynamic parameters (heart rate, systolic, diastolic, and mean blood pressures, breathing rate) were collected. Results: Severe arterial hypotension was noticed in 18.3% of the patients. No statistically significant differences were detected between changes in IVCex, IVCin, and IVC-CI comparing hypotensive and non-hypotensive patients at the baseline and after the interventions (p > 0.005). According to receiver operating characteristic (ROC) analysis, IVC-CI is not effective in the prediction of severe hypotension during spinal anaesthesia in spontaneously breathing patients: the area under the ROC curve for IVC-CI was <0.7, p > 0.05. Conclusions: IVC-CI is not an effective predictor of severe hypotension after induction of spinal anaesthesia followed by normal saline administration in spontaneously breathing patients undergoing elective knee arthroplasty. More trials, including different patient subgroups, will be needed. SN - 1392-0138 UR - https://www.unboundmedicine.com/medline/citation/31281209/Can_the_inferior_vena_cava_collapsibility_index_be_useful_in_predicting_hypotension_during_spinal_anaesthesia_in_a_spontaneously_breathing_patient_A_mini_fluid_challenge_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/31281209/ DB - PRIME DP - Unbound Medicine ER -
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