Assessing the Efficacy of Inferior Vena Cava Collapsibility Index for Predicting Hypotension after Central Neuraxial Block: A Systematic Review and Meta-Analysis

Abstract

The use of ultrasonography to predict spinal-induced hypotension (SIH) has gained significant attention. This diagnostic meta-analysis aimed to investigate the reliability of the inferior vena cava collapsibility index (IVCCI) in predicting SIH in patients undergoing various surgeries. Databases, including Embase, Cochrane Library, Medline, and Google Scholar, were screened until 28 July 2023, yielding 12 studies with 1076 patients (age range: 25.6–79 years) undergoing cesarean section (CS) (n = 4) or non-CS surgeries (n = 8). Patients with SIH had a significantly higher IVCCI than those without SIH (mean difference: 11.12%, 95% confidence interval (CI): 7.83–14.41). The pooled incidence rate of SIH was 40.5%. IVCCI demonstrated satisfactory overall diagnostic reliability (sensitivity, 77%; specificity, 82%). The pooled area under the curve (AUC) was 0.85, indicating its high capability to differentiate patients at risk of PSH. The Fagan nomogram plot demonstrated a positive likelihood ratio (PLR) of 4 and a negative likelihood ratio (NLR) of 0.28. The results underscore the robustness and discriminative ability of IVCCI as a predictive tool for SIH. Nevertheless, future investigations should focus on assessing its applicability to high-risk patients and exploring the potential enhancement in patient safety through its incorporation into clinical practice.

Preoperative Ultrasound for the Prediction of Postinduction Hypotension: A Systematic Review and Meta-Analysis

“…Many advanced monitoring methods are available to assess the fluid responsiveness and volume status, including pulse pressure variation (PPV), dynamic arterial elastance (Edyn), stroke volume variations (SVV), and measurements from ultrasound [7][8][9][10], but the former three are either invasive or limited under spontaneous breathing, and ultrasound is a safe, inexpensive, noninvasive, and real-time diagnostic technique with relatively low costs. Ultrasound was used before induction to evaluate the volume status and predict PIH in an increasing number of studies [9][10][11]. However, the results are conflicting, given the various monitored parameters from ultrasound in different studies [12][13][14].…”

Ultrasound Guided Measurement of Inferior Vena Cava Diameter, Common Carotid Artery Diameter versus Central Venous Pressure for Estimation of Intravascular Volume Status in Septic Shock Patients

“…The CVP had been used for guiding of fluid management for decades. However, it is not devoid of complications (e.g., cardiac injury, arrhythmias, injury of the vascular nerve, pneumothorax, hemothorax, bleeding locally, hematoma, infection, thrombus formation, pulmonary embolism and postphlebitis syndrome (8,9) . In addition, CVP as an accurate measure of volume status has been recently challenged.…”