Mehmet ASIL, Ahmet TOPAL, Gülçin HACIBEYOĞLU, Sema TUNCER UZUN, Sule ARICAN, Mustafa KOYUNCU, Ramazan DERTLİ, Çağdaş DAĞLI

The role of right ventricular volumes and inferior vena cava diameters in the evaluation of volume status before colonoscopy

Background/aim: Ultrasonographic measurements of inferior vena cava (IVC) diameters and right ventricle (RV) volumes areimportant tools for the evaluation of intravascular volume. The current study investigates the association of IVC diameters and RVvolumes before colonoscopy in prediction of postanesthesia hypotension.Materials and methods: Seventy patients scheduled for colonoscopy were included in the study. Preoperatively, expirium (dIVC max)and inspirium (dIVC min) IVC diameters were measured using M-mode ultrasonography and the collapsibility index (IVC-CI) wascalculated. Ventricular volumes and areas were also measured using transthoracic echocardiography. Postanesthesia hypotension wasdefined as mean arterial blood pressure of 30% in the mean arterial pressure after sedation.Results: Minimum and maximum IVC diameters were significantly lower (P = 0.005 and P < 0.001, respectively) and IVC-CI wassignificantly higher (P < 0.001) in patients who developed hypotension. Similarly, right ventricular end-diastolic area (RV-EDA), rightventricular end-systolic area (RV-ESA), right ventricular end-diastolic volume (RV-EDV), right ventricular end-systolic volume (RVESV), and left ventricular end-systolic volume (LV-ESV) values were significantly lower in patients with hypotension (P < 0.05). Logisticregression analysis showed that dIVC min and RV-ESA were independent predictors of hypotension.Conclusion: IVC diameters and RV-ESA, RV-EDA, RV-ESV, and RV-EDV are good indicators of preoperative volume status and can beused to predict the patients at risk of developing hypotension.

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1. Lonjaret L, Lairez O, Minville V, Geeraerts T. Optimal perioperative management of arterial blood pressure. Integrated Blood Pressure Control 2014; 12 (7): 49-59. doi: 10.2147/IBPC. S45292
2. Kratz T, Campo Dell’Orto M, Exner M, Timmesfeld N, Zoremba M et al. Focused intraoperative transthoracic echocardiography by anesthesiologists: a feasibility study. Minerva Anestesiologica 2015; 81 (5): 490-496.
3. Charlson ME, MacKenzie CR, Gold JP, Ales KL, Topkins M et al. Preoperative characteristics predicting intraoperative hypotension and hypertension among hypertensives and diabetics undergoing noncardiac surgery. Annals of Surgery 1990; 212: 66-81.
4. Marik PE, Lemson J. Fluid responsiveness: an evolution of our understanding British Journal of Anaesthesia 2014; 112 (4): 617-620. doi: 10.1093/bja/aet590
5. Brennan JM, Ronan A, Goonewardena S, Blair JE, Hammes M et al. Hand carried ultrasound measurement of the inferior vena cava for assessment of intravascular volume status in the outpatient hemodialysis clinic. Clinical Journal of the American Society of Nephrology 2006; 1 (4): 749-753.
6. DeCara JM, Lang RM, Koch R, Bala R, Penzotti J et al. The use of small personal ultrasound devices by internists without formal training in echocardiography. European Journal of Echocardiography 2002; 4: 141-147.
7. Kirkpatrick JN, Belka V, Furlong K, Balasia B, Jacobs LD et al. Effectiveness of echocardiographic imaging by nurses to identify left ventricular systolic dysfunction in high-risk patients. American Journal of Cardiology 2005; 95: 1271-1272.
8. Zhang J, Critchley LA. Inferior vena cava ultrasonography before general anesthesia can predict hypotension after induction. Anesthesiology 2016; 124 (3): 580-589. doi: 10.1097/ ALN.0000000000001002
9. Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest 2008; 134: 172-178.
10. Cecconi M, Aya HD. Central venous pressure cannot predict fluid-responsiveness. BMC Evidence-Based Medicine 2014; 19 (2): 63.
11. Shah MR, Hasselblad V, Stevenson LW, Binanay C, O’Connor CM et al. Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. JAMA 2005; 294 (13): 1664-1670.
12. Junghans T, Neuss H, Strohauer M, Raue W, Haase O et al. Hypovolemia after traditional preoperative care in patients undergoing colonic surgery is underrepresented in conventional hemodynamic monitoring. International Journal of Colorectal Disease 2006; 21 (7): 693-697.
13. Nette RW, Ie EH, Vletter WB, Krams R, Weimar W et al. Norepinephrine-induced vasoconstriction results in decreased blood volume in dialysis patients. Nephrology Dialysis Transplantation 2006; 21 (5): 1305-1311.
14. Lyon M, Blaivas M, Brannam L. Sonographic measurement of the inferior vena cava as a marker of blood loss. American Journal of Emergency Medicine 2005; 23 (1): 45-50.
15. Stawicki SP, Braslow BM, Panebianco NL, Kirkpatrick JN, Gracias VH et al. Intensivist use of hand-carried ultrasonography to measure IVC collapsibility in estimating intravascular volume status: correlations with CVP. Journal of American College of Surgeons 2009; 209 (1): 55-61. doi: 10.1016/j.jamcollsurg.2009
16. Ferrada P, Anand RJ, Whelan J, Aboutanos MA, Duane T et al. Qualitative assessment of the inferior vena cava: useful tool for the valuation of fluid status in critically ill patients. American Surgeon 2012; 78 (4): 468-470.
17. Prekker ME, Scott NL, Hart D, Sprenkle MD, Leatherman JW. Point-of-care ultrasound to estimate central venous pressure: a comparison of three techniques. Critical Care Medicine 2013; 41 (3): 833-841. doi: 10.1097/CCM.0b013e31827466b7
18. Wallace DJ, Allison M, Stone MB. Inferior vena cava percentage collapse during respiration is affected by the sampling location: an ultrasound study in healthy volunteers. Academic Emergency Medicine 2010; 17 (1): 96-99.
19. Muller L, Bobbia X, Toumi M, Louart G, Molinari N et al. Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure: need for a cautious use. Critical Care 2012; 16 (5): R188. doi: 10.1186/cc11672
20. Airapetian N, Maizel J, Alyamani O, Mahjoub Y, Lorne E et al. Does inferior vena cava respiratory variability predict fluid responsiveness in spontaneously breathing patients? Critical Care 2015; 13 (19): 400. doi: 10.1186/s13054-015-1100-9
21. Salama ER, Elkashlan M. Pre-operative ultrasonographic valuation of inferior vena cava collapsibility index and caval aorta index as new predictors for hypotension after induction of spinal anaesthesia: a prospective observational study. European Journal of Anaesthesiology 2019; 36 (4): 297-302. doi: 10.1097/ EJA.0000000000000956
22. Saranteas T, Spiliotaki H, Koliantzaki I, Koutsomanolis D, Kopanaki E et al. The utility of echocardiography for the prediction of spinal-induced hypotension in elderly patients: inferior vena cava assessment is a key player. Journal of Cardiothoracic and Vascular Anesthesia 2019; 1053 (19): 30181- 30188. doi: 10.1053/j.jvca.2019.02.032
23. Joseph MX, Disney PJ, Da Costa R, Hutchison SJ. Transthoracic echocardiography to identify or exclude cardiac cause of shock. Chest 2004; 126 (5): 1592-1597.
24. Stanko LK, Jacobsohn E, Tam JW, De Wet CJ, Avidan M. Transthoracic echocardiography: impact on diagnosis and management in tertiary care intensive care units. Anaesthesia and Intensive Care 2005; 33 (4): 492-496.
25. Orme RM, Oram MP, McKinstry CE. Impact of echocardiography on patient management in the intensive care unit: an audit of district general hospital practice. British Journal of Anaesthesia 2009; 102 (3): 340-344. doi: 10.1093/bja/aen378
26. Manasia AR, Nagaraj HM, Kodali RB, Croft LB, Oropello JM et al. Feasibility and potential clinical utility of goal-directed transthoracic echocardiography performed by noncardiologist intensivists using a small hand-carried device (SonoHeart) in critically ill patients. Journal of Cardiothoracic and Vascular Anesthesia 2005; 19 (2): 155-159.
27. Jensen MB, Sloth E, Larsen KM, Schmidt MB. Transthoracic echocardiography for cardiopulmonary monitoring in intensive care. European Journal of Anaesthesiology 2004; 21 (9): 700.
28. Holm JH, Frederiksen CA, Juhl-Olsen P, Sloth E. Perioperative use of focus assessed transthoracic echocardiography (FATE). Anesthesia & Analgesia 2012; 115 (5): 1029-1032. doi: 10.1213/ ANE.0b013e31826dd867
29. Jacobsen CJ, Torp P, Sloth E. Perioperative feasibility of imaging the heart and pleura in patients with aortic stenosis undergoing aortic valve replacement. European Journal of Anaesthesiology 2007; 24: 589-595.
30. Tanzola RC, Walsh S, Hopman WM, Sydor D, Arellano R et al. Brief report: Focused transthoracic echocardiography training in a cohort of Canadian anesthesiology residents: a pilot study. Canadian Journal of Anesthesia 2013; 60 (1): 32-37. doi: 10.1007/s12630-012-9811-8
31. Sangalli F, Rubino A. Intraoperative transthoracic echocardiography: another arrow to the bow of perioperative medicine. Minerva Anestesiologica 2015; 81 (5): 469-471.