• Raoul Schorer, Arni Ibsen, Andres Hagerman, Christoph Ellenberger, and Alessandro Putzu.
• From the Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland.
• Anesth. Analg. 2024 Jun 6.

BackgroundArterial hypotension commonly occurs after anesthesia induction and is associated with negative clinical outcomes. Point-of-care ultrasound examination has emerged as a modality to predict postinduction hypotension (PIH). We performed a systematic review and network meta-analysis of the predictive performance of point-of-care ultrasound tests for PIH in noncardiac, nonobstetrical routine adult surgery.MethodsOnline databases were searched for diagnostic test accuracy studies of point-of-care ultrasound for predicting PIH up to March 30, 2023. The systematic review followed the Cochrane methodology. A Bayesian diagnostic test accuracy network meta-analysis model was used, with PIH as defined by study authors as the main outcome. Risk of bias and applicability were examined through the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) score. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess evidence certainty.ResultsA total of 32 studies with 2631 participants were eligible for systematic review. Twenty-six studies with 2258 participants representing 8 ultrasound tests were included in the meta-analysis. Inferior vena cava collapsibility index (22 studies) sensitivity was 60% (95% credible interval [CrI], 49%-72%) and specificity was 83% (CrI, 74%-89%). Carotid artery corrected flow time (2 studies) sensitivity was 91% (CrI, 76%-98%) and specificity was 90% (CrI, 59%-98%). There were serious bias and applicability concerns due to selection bias and inappropriate blinding. The certainty of evidence was very low for all tests.ConclusionsThe predictive performance of point-of-care ultrasound for PIH is uncertain. There is a need for high-quality randomized controlled trials with appropriate blinding and void of selection bias.Copyright © 2024 International Anesthesia Research Society.

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