The validity of ultrasound measurement of subclavian vein variability in volume assessment of elderly patients undergoing hip replacement
WANG Lin
HU Qiangfu
Abstract：Objective To evaluate the efficacy of subclavian vein collapsibility index(SCV-CI)in assessing volume status in elderly patients undergoing hip replacement surgery.Methods This prospective study enrolled 60 elderly pa-tients scheduled for elective hip replacement under general anesthesia combined with nerve block at the Fifth Affiliated Hospital of Zhengzhou University from November 2023 to June 2024.All patients fasted for 8 hours and abstained from flu-ids for 2 hours preoperatively.After standard monitoring(ECG,SpO2,etc.),the FloTrac/Vigileo system was used to mea-sure stroke volume(SV).Following anesthetic induction and endotracheal intubation,ultrasound was performed to deter-mine the maximum(dSCVmax)and minimum(dSCVmin)diameters of the subclavian vein,from which SCV-CI and infe-rior vena cava collapsibility index(IVC-CI)were calculated.A fluid challenge with 7 mL/kg of 6%hydroxyethyl starch 130/0.4 in saline was administered,and SCV-CI/IVC-CI were remeasured 3 minutes post-expansion.Patients were strati-fied by volume responsiveness(ΔSV≥15%:responders;ΔSV<15%:non-responders).Correlation analyses compared SCV-CI and IVC-CI before/after expansion.Receiver operating characteristic(ROC)curves were plotted to determine the optimal predictive threshold of SCV-CI,with area under the curve(AUC)calculated.Results Both SCV-CI and IVC-CI demonstrated significant positive correlations before and after fluid expansion(pre-expansion:r=0.782,P<0.05;post-ex-pansion:r=0.463,P<0.05).ROC analysis revealed that SCV-CI had an AUC of 0.863 for predicting fluid responsive-ness in elderly hip replacement patients.At a cutoff value of≥22.85%,SCV-CI exhibited a sensitivity of 87.2%and spec-ificity of 85.7%.Similarly,IVC-CI showed an AUC of 0.894,with an optimal threshold of≥29.65%,yielding a sensitivi-ty of 89.7%and specificity of 90.5%.Conclusions As an alternative volume assessment indicator,SCV-CI can effec-tively evaluate volume responsiveness.The value of 22.85%serves as the optimal cutoff for assessing intraoperative vol-ume responsiveness in elderly patients undergoing hip arthroplasty.
Keywords：subclavian vein collapsibilityinferior vena cava collapsibilityhip replacementstroke volumeaged
Publication Date：2025-06-25
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 4-8 )