Pôle Anesthésie Réanimation, Hôpital Militaire Avicenne, 1 Avenue Al Mouqaouama, 40015, Marrakesh, Morocco; Laboratoire Biosciences et Santé, Faculté de Médecine et de Pharmacie, Université Cadi Ayyad, 40000, Marrakesh, Morocco.
Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital l'Archet 1, 151 route saint Antoine de Ginestière, 06200, Nice, France; UR2CA, Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France.
Anaesth Crit Care Pain Med. 2022 Aug;41(4):101090. doi: 10.1016/j.accpm.2022.101090. Epub 2022 May 1.
Post-induction hypotension (PIH) is a common side effect of general anaesthesia and is associated with poor perioperative outcomes. We assessed the ability of two point-of-care echocardiographic variables to predict the occurrence of PIH: the passive leg raising-induced changes in the velocity-time integral of the left ventricular outflow tract (ΔVTI-PLR) and the inferior vena cava collapsibility index (IVC-CI).
We studied 64 patients > 50 years scheduled for elective abdominal surgery. ΔVTI-PLR and IVC-CI were prospectively obtained before general anaesthesia induction. PIH was defined by a systolic arterial pressure < 90 mmHg or a mean arterial pressure < 65 mmHg or by a decrease in systolic or mean arterial pressure > 30% from pre-induction level. Intraclass correlation coefficients (ICCs) were calculated to assess the reproducibility of echocardiographic measurements. Receiver operating characteristic (ROC) curves with 95% confidence intervals (CIs) were generated to test the ability of ΔVTI-PLR and IVC-CI to predict the occurrence of PIH.
PIH occurred in 33 (51%) patients. The ICCs for VTI and IVC measurements showed excellent reproducibility. The occurrence of PIH was accurately predicted by ΔVTI-PLR with an area under the ROC curve (AUROC) of 0.89 (95% CI: 0.80-0.97), a threshold value of 18% with a sensitivity of 88% (95% CI: 71-97%) and a specificity of 84% (95% CI: 66-94%). The occurrence of PIH was poorly predicted by IVC-CI with an AUROC of 0.68 (95% CI: 0.54-0.80) and a threshold value of 42%.
ΔVTI-PLR, unlike IVC-CI, could reliably predict the occurrence of PIH. The use of ΔVTI-PLR could help individualise anaesthesia management to prevent PIH.
诱导后低血压（PIH）是全身麻醉的常见副作用，与围手术期不良结局有关。我们评估了两种即时超声心动图变量预测 PIH 发生的能力：被动抬腿引起的左心室流出道速度时间积分变化（ΔVTI-PLR）和下腔静脉塌陷指数（IVC-CI）。
我们研究了 64 名>50 岁拟行择期腹部手术的患者。在全身麻醉诱导前前瞻性地获得了 ΔVTI-PLR 和 IVC-CI。PIH 的定义为收缩压<90mmHg 或平均动脉压<65mmHg，或收缩压或平均动脉压从诱导前水平下降>30%。计算了组内相关系数（ICC）以评估超声心动图测量的可重复性。生成了具有 95%置信区间（CI）的受试者工作特征（ROC）曲线，以测试 ΔVTI-PLR 和 IVC-CI 预测 PIH 发生的能力。
33 例（51%）患者发生 PIH。VTI 和 IVC 测量的 ICC 显示出极好的可重复性。ΔVTI-PLR 可准确预测 PIH 的发生，ROC 曲线下面积（AUROC）为 0.89（95%CI：0.80-0.97），阈值为 18%，敏感性为 88%（95%CI：71-97%），特异性为 84%（95%CI：66-94%）。IVC-CI 预测 PIH 的发生能力较差，AUROC 为 0.68（95%CI：0.54-0.80），阈值为 42%。
与 IVC-CI 不同，ΔVTI-PLR 可以可靠地预测 PIH 的发生。ΔVTI-PLR 的使用可以帮助个体化麻醉管理，以预防 PIH。
