Comparing preoperative fasting and ultrasound-measured intravascular volume status in elective surgery, enhanced recovery patients versus inpatient, urgent surgery patients and the ability of IVC collapsibility to predict post-induction hypotension.
Jacob R Wrobel, Justin C Magin, David Williams and 9 others
PMID 38149485WHAT IT FOUND
Urgent inpatients fasted 13.7 hours on average versus 2.56 hours for elective ERAS patients.
Despite higher thirst and signs of lower volume in the fasting group, ultrasound measures did not significantly predict post-induction hypotension.
Key findings
01Inpatient urgent surgery patients had significantly longer fasting times and higher thirst prevalence compared to elective ERAS patients.
02IVC collapsibility index was significantly higher in the urgent inpatient group, indicating lower intravascular volume.
03IVC collapsibility was not a statistically significant predictor of post-induction hypotension in this study.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was underpowered to detect differences in hypotension rates or to confirm IVC collapsibility as a predictor; a larger sample size of 75 was estimated to be needed for the association analysis. The definition of post-induction hypotension included vasopressor use, which may reflect clinician judgment rather than a strict physiological threshold. Single-centre design and exclusion of patients with severe cardiac or vascular disease limits generalisability to complex comorbid populations.
Declared interests
The authors declared no conflicts of interest. Funding was provided by the Carolina Medical Student Research Program.
The easy way to misread this
Do not conclude that IVC collapsibility is a useless screening tool. The study was underpowered to detect the association, and the lack of statistical significance does not prove the absence of a clinical relationship between volume status and hypotension.