Comparison of ultrasound-based measures of inferior vena cava and internal jugular vein for prediction of hypotension during induction of general anesthesia

Figures & data

Figure 1. The AUC analysis for the ability to predict severe post-induction hypotension.

AUC: area under receiver operating characteristic curve, IJV: internal jugular vein, IVC: inferior vena cava.

Figure 2. The AUC analysis for the ability to predict prolonged post-induction hypotension.

AUC: area under receiver operating characteristic curve, IJV: internal jugular vein, IVC: inferior vena cava.

Table 1. Demographic data and hemodynamic characteristics. Presenting data as median (quartiles) and frequency (percentage).

Age (years)	32 [23, 43]
Male sex	72 (44%)
ASA physical status I II	117 (72%) 16 (10%)
Weight (kg)	74 (63, 83)
Height (cm)	166 (157, 175)
Inferior vena cava Maximum diameter (mm) Minimum diameter (mm) Collapsibility index	15.6 (13.2, 18.2) 10.2 (8.1, 12.2 0.36 (0.25, 0.45)
Internal jugular vein Supine area (mm^2) Trendelenburg area (mm^2) Change rate	9.7 (6.8, 14.5) 14.7 (9.8, 19.3) 0.24 (0.13, 0.39)
Baseline systolic blood pressure (mmHg)	123 (111, 135)
Baseline mean blood pressure (mmHg)	89 (81, 98)
Baseline heart rate (bpm)	83 (75, 90)
Total norepinephrine dose (mcg)	10 [5,20]
Incidence of severe post-induction hypotension	12 (9%)
Incidence of prolonged post-induction hypotension	84 (63%)
Incidence of bradycardia	16 (12%)
Time to hypotensive episode (minutes)	2 [1,5]
Time to skin incision (minutes)	15 [12,15]

Table 2. Demographic data and hemodynamic characteristics in hypotensive and non-hypotensive patients. Presenting data as median (quartiles) and frequency (percentage).

	Non-hypotension (n = 49)	Hypotension (n = 84)	P-value
Age (years)	31 [24, 39]	33 [22, 45]	0.422
Male sex	28 (57%)	44 (52%)	0.595
ASA physical status I II	46 (94%) 3 (6%)	71 (85%) 13 (15%)	0.110
Weight (kg)	73 (62, 82)	75 (64, 85)	0.422
Height (cm)	171 (158, 176)	165 (156, 175)	0.249
Inferior vena cava Maximum diameter (mm) Minimum diameter (mm) Collapsibility index	15.9 (13.2, 18.9) 11.0 (8.9, 12.5) 0.3 (0.2, 0.4)	15.4 (13.2, 18.0) 9.8 (7.8, 12.0) 0.4 (0.3, 0.5)	0.437 0.115 0.070
Internal jugular vein Supine area (mm^2) Trendelenburg area (mm^2) Change rate	10.0 (7.2, 16.6) 14.8 (9.4, 19.9) 0.2 (0.1, 0.3)	9.5 (6.5, 12.9) 14.6 (10.1, 19.0) 0.3 (0.2, 0.4)	0.184 0.792 0.033*
Baseline Systolic blood pressure (mmHg)	119 (111, 131)	127 (113, 140)	0.025*
Baseline mean blood pressure (mmHg)	85 (77, 93)	91 (83, 103)	0.004*
Baseline heart rate (bpm)	82 (75, 90)	83 (74, 90)	0.663

Table 3. Accuracy of IVC and IJV parameters in predicting severe post-induction hypotension.

	AUC (95%CI)	Sensitivity % (95% CI)	Specificity % (95% CI)	PPV % (95% CI)	NPV % (95% CI)	Cut-off value
Maximum diameter	0.56 (0.47–0.64)	75 (43–95)	46 (37–56)	12 [6–22]	95 (86–99)	≤16.3 mm
Minimum diameter	0.58 (0.49–0.66)	67 (35–90)	50 (41–60)	12 [5–22]	94 (85–98)	≤10.3 mm
Collapsibility index	0.56 (0.47–0.64)	50 (21–79)	70 (61–78)	14 (5–29)	93 (86–98)	>0.42
Supine area	0.56 (0.47–0.65)	83 (52–98)	37 (29–46)	12 [6–20]	96 (86–100)	≤11.9 mm2
Trendelenburg area	0.56 (0.47–0.64)	75 (43–95)	64 (44–63)	14 [7–25]	96 (88–99)	>14.8 mm2
Change rate	0.74 (0.66–0.81)	75 (43–95)	72 (63–80)	21 (10–36)	97 (91–99)	>0.35

AUC: area under receiver operating characteristic curve, CI: confidence interval, PPV: positive predictive value, NPV: negative predictive value.

Table 4. Accuracy of IVC and IJV parameters in predicting prolonged post-induction hypotension.

	AUC (95%CI)	Sensitivity % (95% CI)	Specificity % (95% CI)	PPV % (95% CI)	NPV % (95% CI)	Cut-off value
Inferior Vena Cava
Maximum diameter	0.54 (0.45–0.63)	70 (59–80)	43 (29–58)	68 (57–77)	46 (31–61)	≤17.3 mm
Minimum diameter	0.58 (0.49–0.67)	36 (26–47)	84 (70–93)	79 (63–90)	43 (33–54)	≤8.4 mm
Collapsibility index	0.59 (0.51–0.68)	57 (46–68)	67 (53–80)	75 (63–85)	48 (36–60)	>0.363
Internal Jugular Vein
Supine area	0.60 (0.48–0.66)	82 (72–90)	41 (27–56)	70 (60–79)	57 (39–74)	≤14.4 mm2
Trendelenburg area	0.51 (0.43–0.60)	70 (59–80)	39 (25–54)	66 (56–76)	43 (28–59)	≤17.4 mm2
Change rate	0.61 (0.52–0.69)	55 (44–66)	76 (61–87)	79 (67–89)	49 (38–61)	>0.28

AUC: area under receiver operating characteristic curve, CI: confidence interval, PPV: positive predictive value, NPV: negative predictive value.

Table

GA	General Anesthesia
ACEI	Angiotensin converting enzyme inhibitor
ANOVA	Analysis of variance
ARB	Angiotensin receptor blocker
ASA	American Society of Anesthesiologists
AUR
AUROC	Area under receiver operating characteristic curve
CI	Collapsibility index
CVP	Central venous pressure
dIVCmax	Maximum diameter of inferior vena cava
dIVCmin	Minimum diameter of inferior vena cava
IJV	Internal jugular vein
IVC	Inferior vena cava
MAC	Minimum alveolar concentration
MBP	Mean blood pressure