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Demir I, Turktan M, Gulec E, Arslan YK, Ozalevli M. The predictive role of carotid artery flow time for anesthesia-induced hypotension in high-risk elderly patients. J Clin Monit Comput 2024; 38:859-867. [PMID: 38609724 DOI: 10.1007/s10877-024-01145-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/25/2024] [Indexed: 04/14/2024]
Abstract
Hypotension induced by general anesthesia is associated with postoperative complications, increased mortality, and morbidity, particularly elderly patients. The aim of this study was to investigate the effectiveness of corrected carotid artery flow time (FTc) for predicting hypotension following anesthesia induction in patients over 65 years old. After faculty ethical committee approval and written informed consent, 138 patients (65 years and older, ASA physical status I-III) who scheduled for elective surgery were included in this study. In the pre-operative anesthesia unit, the carotid artery FTc value was measured by ultrasound and hemodynamic values were recorded. Following anesthesia induction with propofol, hemodynamic data were recorded at 1-minute intervals for 3 min. Measurements were terminated prior to endotracheal intubation, as direct laryngoscopy and endotracheal intubation could cause sympathetic stimulation and hemodynamic changes. Hypotension occurred in 52 patients (37.7%). The preoperative FTc value of the patients who developed hypotension was statistically lower (312.5 ms) than the patients who did not (345.0 ms) (p < 0.001). The area under the ROC curve for carotid artery FTc was 0.93 (95% CI for AUC:0.89-0.97; p < 0.001) with an optimal cut-off of value for predicting post-anesthesia hypotension 333 ms, a sensitivity of 90.4% and a specificity of 84.9%. As a result of the multiple logistic regression model, carotid artery FTc emerged as the sole independent risk factor for hypotension following anesthesia induction. Preoperative carotid artery FTc measurement is a simple, bedside, noninvasive, and reliable method for predicting anesthesia-induced hypotension in elderly patients.
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Affiliation(s)
- Ismail Demir
- Department of Anesthesiology and Reanimation, Cukurova University, Adana, Turkey
| | - Mediha Turktan
- Department of Anesthesiology and Reanimation, Cukurova University, Adana, Turkey.
| | - Ersel Gulec
- Department of Anesthesiology and Reanimation, Cukurova University, Adana, Turkey
| | | | - Mehmet Ozalevli
- Department of Anesthesiology and Reanimation, Cukurova University, Adana, Turkey
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Li M, Li F, Yu J, Tang X, Zhou C, Chen Q, Liu H. The impact of pre-rehydration guided by carotid corrected flow time on hypotension prevention following general anesthesia induction in patients undergoing gastrointestinal surgery: a prospective randomized controlled trial. Front Med (Lausanne) 2024; 11:1416574. [PMID: 38895180 PMCID: PMC11184214 DOI: 10.3389/fmed.2024.1416574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
Background Patients undergoing gastrointestinal surgery often experience hypotension following general anesthesia induction due to insufficient volume. This study aimed to assess whether pre-rehydration guided by carotid corrected flow time (FTc) could mitigate post-induction hypotension induced by general anesthesia. Methods Patients undergoing resection of gastrointestinal tumors were assigned to either the conventional treatment group (Group C) or the fluid treatment group based on FTc (Group F). Within Group F, patients were further divided into Group A (carotid FTc <340.7 ms) and Group B (carotid FTc ≥340.7 ms) based on pre-rehydration carotid FTc values. Group A patients received pre-rehydration with 250 mL of colloids (hydroxyethyl starch-HES) administered within 15 min until carotid FTc reached ≥340.7 ms to counteract hypovolemia prior to induction. Patients in Group B and Group C received a continuous HES infusion at a rate of 6 mL/kg/h 30 min before induction to compensate for physiological fluid loss. All patients received a perioperative background infusion of 3 mL/kg/h compound sodium chloride, with infusion rates optimized based on mean arterial pressure (MAP) and heart rate (HR). The incidence of post-induction hypotension was compared between Group C and Group F, as well as between Group A and Group B. Results The incidence of hypotension after induction was significantly lower in Group F compared to Group C (26.4% vs. 46.7%, respectively; p < 0.001). Patients in Group A received significantly more pre-rehydration, leading to a greater increase in carotid FTc values compared to Group B (336.5 ± 64.5 vs. 174.3 ± 34.1 ms, p = 0.002). However, no significant difference in carotid FTc values after pre-rehydration was observed between the groups. There was no significant difference in the incidence of hypotension after general anesthesia induction between Group A and Group B (22.9% vs. 28.8%, p = 0.535). Conclusion Pre-rehydration based on FTc can effectively reduce the occurrence of post-induction hypotension in patients undergoing gastrointestinal surgery who present with insufficient volume. Clinical trial registration https://www.chictr.org.cn/showprojEN.html?proj=201481.
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Affiliation(s)
- Min Li
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Feng Li
- Department of Anesthesiology, Zibo First Hospital, Zibo, China
| | - Jiali Yu
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Xixi Tang
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Chengfu Zhou
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Qi Chen
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Hongliang Liu
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
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Liu C, An R, Liu H. Preoperative Ultrasound for the Prediction of Postinduction Hypotension: A Systematic Review and Meta-Analysis. J Pers Med 2024; 14:452. [PMID: 38793034 PMCID: PMC11122148 DOI: 10.3390/jpm14050452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
Postinduction hypotension (PIH) is closely associated with postoperative adverse outcomes. Preoperative hypovolemia is a key risk factor, and many parameters are available from ultrasound to detect hypovolemia, but the accuracy of PIH from ultrasound remains unclear. This systematic review and meta-analysis aimed to evaluate the commonly used measurements from ultrasound to predict PIH. We searched the PubMed, Cochrane Library, Embase, CNKI, and Web of Science databases from their inception to December 2023. Thirty-six studies were included for quantitative analysis. The pooled sensitivities for the inferior vena cava collapsibility index (IVC-CI), maximum inferior vena cava diameter (DIVCmax), minimum inferior vena cava diameter (DIVCmin), and carotid artery corrected flow time (FTc) were 0.73 (95% CI = 0.65, 0.79), 0.66 (95% CI = 0.54, 0.77), 0.74 (95% CI = 0.60, 0.85), and 0.81 (95% CI = 0.72, 0.88). The pooled specificities for the IVC-CI, DIVCmax, DIVCmin, and carotid artery FTc were 0.82 (95% CI = 0.75, 0.87), 0.75 (95% CI = 0.66, 0.82), 0.76 (95% CI = 0.65, 0.84), and 0.87 (95% CI = 0.77, 0.93). The AUC for the IVC-CI, DIVCmax, DIVCmin, and carotid artery FTc were 0.84 (95% CI = 0.81, 0.87), 0.77 (95% CI = 0.73, 0.81), 0.82 (95% CI = 0.78, 0.85), and 0.91 (95% CI = 0.88, 0.93). Our study demonstrated that ultrasound indices are reliable predictors for PIH. The carotid artery FTc is probably the optimal ultrasound measurement for identifying patients who will develop PIH in our study.
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Affiliation(s)
| | | | - Hongliang Liu
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing 400030, China; (C.L.); (R.A.)
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Huang S, Liao Z, Chen A, Wang J, Xu X, Zhang L. Effect of carotid corrected flow time combined with perioperative fluid therapy on preventing hypotension after general anesthesia induction in elderly patients: a prospective cohort study. Int J Surg 2024; 110:799-809. [PMID: 37983823 PMCID: PMC10871564 DOI: 10.1097/js9.0000000000000863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/22/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Hypotension often occurs following the induction of general anesthesia in elderly patients undergoing surgery and can lead to severe complications. This study assessed the effect of carotid corrected flow time (FTc) combined with perioperative fluid therapy on preventing hypotension after general anesthesia induction in elderly patients. MATERIALS AND METHODS The prospective cohort study was divided into two parts. The first part (Part I) consisted of 112 elderly patients. Carotid FTc was measured using Color Doppler Ultrasound 5 min before anesthesia induction. Hypotension was defined as a decrease of greater than 30% in systolic blood pressure (SBP) or a decrease of greater than 20% in mean arterial pressure (MAP) from baseline, or an absolute SBP below 90 mmHg and MAP below 60 mmHg within 3 min after induction of general anesthesia. The predictive value of carotid FTc was determined using receiver operating characteristic (ROC) curve. The second part (Part II) consisted of 65 elderly patients. Based on the results in Part I, elderly patients with carotid FTc below the optimal cut-off value received perioperative fluid therapy at a volume of 8 ml/kg of balanced crystalloids (lactated Ringer's solution) in 30 min before induction. The effect of carotid FTc combined with perioperative fluid therapy was assessed by comparing observed incidence of hypotension after induction. RESULTS The area under the ROC for carotid FTc to predict hypotension after induction was 0.876 [95% confidence interval (CI) 0.800-0.952, P <0.001]. The optimal cut-off value was 334.95 ms (sensitivity of 87.20%; specificity of 82.20%). The logistic regression analysis revealed that carotid FTc is an independent predictor for post-induction hypotension in elderly patients. The incidence of post-induction hypotension was significantly lower ( P <0.001) in patients with carotid FTc less than 334.95 ms who received perioperative fluid therapy (35.71%) compared to those who did not (92.31%). CONCLUSIONS Carotid FTc combined with the perioperative fluid therapy could significantly reduce the incidence of hypotension after the induction of general anesthesia in elderly patients.
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Affiliation(s)
- Shishi Huang
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou
| | - Zhenqi Liao
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou
| | - Andi Chen
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, People’s Republic of China
| | - Jiali Wang
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou
| | - Xiaodong Xu
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou
| | - Liangcheng Zhang
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou
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Jin G, Liu F, Yang Y, Chen J, Wen Q, Wang Y, Yu L, He J. Carotid blood flow changes following a simulated end-inspiratory occlusion maneuver measured by ultrasound can predict hypotension after the induction of general anesthesia: an observational study. BMC Anesthesiol 2024; 24:13. [PMID: 38172775 PMCID: PMC10763470 DOI: 10.1186/s12871-023-02393-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The primary purpose of this study was to investigate the predictive value of alterations in cervical artery hemodynamic parameters induced by a simulated end-inspiratory occlusion test (sEIOT) measured by ultrasound for predicting postinduction hypotension (PIH) during general anesthesia. METHODS Patients undergoing gastrointestinal tumor resection under general anesthesia were selected for this study. Ultrasound has been utilized to assess hemodynamic parameters in carotid artery blood flow before induction, specifically focusing on variations in corrected flow time (ΔFTc) and peak blood flow velocity (ΔCDPV), both before and after sEIOT. Anesthesia was induced by midazolam, sufentanil, propofol, and rocuronium, and blood pressure (BP) and heart rate (HR) were recorded within the first 10 min following endotracheal intubation. PIH was defined as fall in systolic blood pressure (SBP) or mean arterial pressure (MAP) by > 30% of baseline or MAP to < 60 mm Hg. RESULTS The area under the receiver operating characteristic curves (AUC) for carotid artery ΔFTc was 0.88 (95%CI, 0.81 to 0.96; P < 0.001), and the optimal cutoff value was -16.57%, with a sensitivity of 91.4% and specificity of 77.60%. The gray zone for carotid artery ΔFTc was -16.34% to -15.36% and included 14% of the patients. The AUC for ΔCDPV was 0.54, with an optimal cutoff value of -1.47%. The sensitivity and specificity were calculated as 55.20% and 57.10%, respectively. CONCLUSION The corrected blood flow time changes in the carotid artery induced by sEIOT can predict hypotension following general anesthesia-induced hypotension, wherein ΔFTc less than 16.57% is the threshold. TRIAL REGISTRATION Chinese Clinical Trial Registry ( www.chictr.org.cn ; 20/06/2023; ChiCTR2300072632).
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Affiliation(s)
- Guangshan Jin
- School of Anesthesiology, Xuzhou Medical University, Jiangsu, China
| | - Fuqiang Liu
- Department of Anesthesiology, Jiangsu Cancer Hospital, The Affricated Cancer Hospital of Nanjing Medical University, Jiangsu, China
| | - Yiwen Yang
- School of Anesthesiology, Xuzhou Medical University, Jiangsu, China
| | - Jiahui Chen
- School of Anesthesiology, Xuzhou Medical University, Jiangsu, China
| | - Qian Wen
- Department of Anesthesiology, Jiangsu Cancer Hospital, The Affricated Cancer Hospital of Nanjing Medical University, Jiangsu, China
| | - Yudong Wang
- School of Anesthesiology, Xuzhou Medical University, Jiangsu, China
| | - Ling Yu
- Department of Ultrasound, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu, China
| | - Jianhua He
- School of Anesthesiology, Xuzhou Medical University, Jiangsu, China.
- Department of Anesthesiology, Jiangsu Cancer Hospital, The Affricated Cancer Hospital of Nanjing Medical University, Jiangsu, China.
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Kerrebijn I, Atwi S, Horner C, Elfarnawany M, Eibl AM, Eibl JK, Taylor JL, Kim CH, Johnson BD, Kenny JÉS. Correlation between changing carotid artery corrected flow time and ascending aortic Doppler flow velocity. Br J Anaesth 2023; 131:e192-e195. [PMID: 37863770 DOI: 10.1016/j.bja.2023.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/22/2023] Open
Affiliation(s)
| | | | | | | | - Andrew M Eibl
- Flosonics Medical, Toronto, ON, Canada; Health Sciences North Research Institute, Sudbury, ON, Canada
| | - Joseph K Eibl
- Flosonics Medical, Toronto, ON, Canada; Health Sciences North Research Institute, Sudbury, ON, Canada; Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Jenna L Taylor
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA; School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Chul Ho Kim
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Bruce D Johnson
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Jon-Émile S Kenny
- Flosonics Medical, Toronto, ON, Canada; Health Sciences North Research Institute, Sudbury, ON, Canada
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Chowdhury AR, Thakuria R, Maitra S, Nath S, Baidya DK, Subramanium R, Anand RK, Kayina CA. Carotid artery corrected flow time and respiratory variation of blood flow peak velocity for prediction of hypotension after induction of general anesthesia in adult patients undergoing emergency laparotomy for peritonitis: A prospective, observational study. J Anaesthesiol Clin Pharmacol 2023; 39:444-450. [PMID: 38025582 PMCID: PMC10661613 DOI: 10.4103/joacp.joacp_372_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 12/01/2023] Open
Abstract
Background and Aims Doppler waveform analysis of carotid artery has been found to predict fluid responsiveness in patients undergoing elective surgeries. We evaluated the role of carotid artery corrected flow time (FTc) and respiratory variation of blood flow peak velocity (ðVpeak) in predicting post induction hypotension in patients undergoing emergency laparotomy for peritonitis. Material and Methods Adult patients (n = 60) with perforation peritonitis undergoing emergency laparotomy under general anesthesia (GA) were recruited in this prospective, observational study. Carotid ultrasonography was performed pre-induction, to determine FTc and ðVpeak. Post-induction hemodynamic parameters were recorded for 5 minutes. Spearman's rank correlation coefficient was used to determine the relationship between hypotension and carotid artery measurements. Results Post-induction hypotension occurred in 48.3% of patients. The carotid artery FTc was significantly lower (P = 0.008) in patients who developed post-induction hypotension, but ðVpeak was statistically similar (P = 0.62) in both groups. Spearman's rank correlation coefficient revealed a statistically significant correlation between FTc and systolic blood pressure (SBP) change at one-minute post induction (r2 = -0.29, P = 0.03); however statistical significance were not achieved at 2 minutes and 3 minutes (P = 0.05 at both time points). Carotid artery FTc had an area under the receiver operating characteristic (AUROC) curve (95% CI) of 0.70 (0.57-0.84) to predict post-induction hypotension and best cutoff value of 344.8 ms with a sensitivity and specificity of 61% and 79%, respectively. Carotid artery ðVpeak had an AUROC curve (95% CI) of 0.54 (0.39-0.69) to predict post-induction hypotension and best cutoff value of 7.9% with a sensitivity and specificity of 62% and 55%, respectively. Conclusion Carotid artery FTc and ðVpeak are not reasonable predictors of hypotension in patients undergoing emergency laparotomy for perforation peritonitis.
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Affiliation(s)
- Apala R. Chowdhury
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
- Department of Anaesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ruma Thakuria
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
- Department of Anaesthesia and Critical Care, Max Hospital, Dehradun, Uttarakhand, India
| | - Souvik Maitra
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Sayan Nath
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Dalim K. Baidya
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeshwari Subramanium
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul K. Anand
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Choro A. Kayina
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Kenny JÉS, Gibbs SO, Johnston D, Yang Z, Hofer LM, Elfarnawany M, Eibl JK, Johnson A, Buecker AJ, Lau VC, Kemp BO. The time cost of physiologically ineffective intravenous fluids in the emergency department: an observational pilot study employing wearable Doppler ultrasound. J Intensive Care 2023; 11:7. [PMID: 36793079 PMCID: PMC9933329 DOI: 10.1186/s40560-023-00655-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Little data exist on the time spent by emergency department (ED) personnel providing intravenous (IV) fluid to 'responsive' versus 'unresponsive' patients. METHODS A prospective, convenience sample of adult ED patients was studied; patients were enrolled if preload expansion was indicated for any reason. Using a novel, wireless, wearable ultrasound, carotid artery Doppler was obtained before and throughout a preload challenge (PC) prior to each bag of ordered IV fluid. The treating clinician was blinded to the results of the ultrasound. IV fluid was deemed 'effective' or 'ineffective' based on the greatest change in carotid artery corrected flow time (ccFT∆) during the PC. The duration, in minutes, of each bag of IV fluid administered was recorded. RESULTS 53 patients were recruited and 2 excluded for Doppler artifact. There were 86 total PCs included in the investigation comprising 81.7 L of administered IV fluid. 19,667 carotid Doppler cardiac cycles were analyzed. Using ccFT∆ ≥ + 7 ms to discriminate 'physiologically effective' from 'ineffective' IV fluid, we observed that 54 PCs (63%) were 'effective', comprising 51.7 L of IV fluid, whereas, 32 (37%) were 'ineffective' comprising 30 L of IV fluid. 29.75 total hours across all 51 patients were spent in the ED providing IV fluids categorized as 'ineffective.' CONCLUSIONS We report the largest-known carotid artery Doppler analysis (i.e., roughly 20,000 cardiac cycles) in ED patients requiring IV fluid expansion. A clinically significant amount of time was spent providing physiologically ineffective IV fluid. This may represent an avenue to improve ED care efficiency.
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Affiliation(s)
- Jon-Émile S. Kenny
- grid.420638.b0000 0000 9741 4533Health Sciences North Research Institute, 56 Walford Road, Sudbury, ON P3E2H3 Canada ,Flosonics Medical 325 W. Front Street, Toronto, ON M5V2Y1 Canada
| | - Stanley O. Gibbs
- Flosonics Medical 325 W. Front Street, Toronto, ON M5V2Y1 Canada
| | - Delaney Johnston
- Flosonics Medical 325 W. Front Street, Toronto, ON M5V2Y1 Canada
| | - Zhen Yang
- Flosonics Medical 325 W. Front Street, Toronto, ON M5V2Y1 Canada
| | - Lisa M. Hofer
- Flosonics Medical 325 W. Front Street, Toronto, ON M5V2Y1 Canada
| | - Mai Elfarnawany
- Flosonics Medical 325 W. Front Street, Toronto, ON M5V2Y1 Canada
| | - Joseph K. Eibl
- grid.420638.b0000 0000 9741 4533Health Sciences North Research Institute, 56 Walford Road, Sudbury, ON P3E2H3 Canada ,Flosonics Medical 325 W. Front Street, Toronto, ON M5V2Y1 Canada ,grid.436533.40000 0000 8658 0974Northern Ontario School of Medicine, 935 Ramsey Lake Road, Sudbury, ON P3E2C6 Canada
| | - Amanda Johnson
- grid.416495.b0000 0004 0383 0587OSF Saint Francis Medical Center, 530 NE Glen Oak Ave, Peoria, IL 61637 USA
| | - Anthony J. Buecker
- grid.416495.b0000 0004 0383 0587OSF Saint Francis Medical Center, 530 NE Glen Oak Ave, Peoria, IL 61637 USA
| | - Vivian C. Lau
- grid.416495.b0000 0004 0383 0587OSF Saint Francis Medical Center, 530 NE Glen Oak Ave, Peoria, IL 61637 USA
| | - Benjamin O. Kemp
- grid.416495.b0000 0004 0383 0587OSF Saint Francis Medical Center, 530 NE Glen Oak Ave, Peoria, IL 61637 USA
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Khan S, Mishra SK, Parida S, Jha AK, Nagabhushanam Padala SRA. Carotid doppler indices do not predict fluid responsiveness in mechanically ventilated patients undergoing coronary artery bypass grafting surgery. J Card Surg 2022; 37:4418-4424. [PMID: 36251251 DOI: 10.1111/jocs.17035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/07/2022] [Accepted: 09/06/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY This study aimed to determine the predictive value of carotid artery blood flow (CABF), corrected carotid flow time (CFT), and respiratory variation in carotid peak systolic velocity (DVPeakCA) for fluid responsiveness in mechanically ventilated patients undergoing coronary artery bypass grafting (CABG) surgery. It also aimed to correlate each of these indices with changes in stroke volume index (SVI) after a fluid bolus. METHODS This prospective, interventional, before-after study recruited 45 adult patients undergoing CABG. Following induction of anesthesia, a fluid challenge of 6 ml/kg of a crystalloid solution was delivered over 10 min. Mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), CABF, CFT, and DVPeakCA were recorded before and following the intervention. Patients with an increase in SVI of >15% from baseline were considered responders. RESULTS We had 22 responders and 23 nonresponders. Areas under the receiver operating characteristic (AUROC) curves for the studied indices (CABF, 0.516, CFT, 0.502, and DVPeakCA, 0.671) did not suggest any strong predictive value to detect fluid responsiveness. Similarly, the r values for correlation of these carotid doppler-derived indices, both baseline and as % change from baseline with the % alteration of SVI were all <0.2, which demonstrates a very weak correlation between these variables. CONCLUSIONS Carotid doppler indices are unreliable to assess fluid responsiveness, and cannot replace invasive methods of analyzing preload optimization. There was no significant correlation between carotid doppler-derived indices and alterations in SVI before and after the fluid bolus.
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Affiliation(s)
- Saba Khan
- Department of Anaesthesiology, Universal College of Medical Sciences, Bhairahawa, Nepal
| | | | - Satyen Parida
- Department of Anaesthesiology& Critical Care, JIPMER, Pondicherry, India
| | - Ajay Kumar Jha
- Department of Anaesthesiology& Critical Care, JIPMER, Pondicherry, India
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Wang J, Li Y, Su H, Zhao J, Tu F. Carotid artery corrected flow time and respiratory variations of peak blood flow velocity for prediction of hypotension after induction of general anesthesia in elderly patients. BMC Geriatr 2022; 22:882. [DOI: 10.1186/s12877-022-03619-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022] Open
Abstract
Abstract
Background
Postinduction hypotension is closely related to postoperative complications. Elderly patients with compromised cardiovascular compensatory reserve are more susceptible to hypotension after induction of general anesthesia. This study investigated whether the carotid artery corrected flow time (FTc) and respiratory variation of peak blood flow velocity in the common carotid artery (ΔVpeak) could predict postinduction hypotension in elderly patients.
Methods
This prospective observational study included elderly patients aged 65 to 75 who were scheduled for elective surgery under general anesthesia with ASA physical status class of I-II, without cardiovascular disease, hypertension, diabetes, or obesity. Anesthesia was induced by midazolam, sufentanil, and etomidate and was maintained by sevoflurane. The carotid artery FTc and ΔVpeak were measured by ultrasound before induction of anesthesia. Hemodynamic data were recorded before induction and then during the first 10 min after induction.
Results
Ninety-nine patients were included in the final analysis, of whom 63 developed postinduction hypotension. The area under the receiver operating characteristic curves was 0.87 (0.78 to 0.93) for carotid artery FTc and 0.67 (0.56 to 0.76) for ΔVpeak, respectively. The optimal cutoff value for predicting postinduction hypotension was 379.1 ms for carotid artery FTc, with sensitivity and specificity of 72.2 and 93.7%, respectively. The best cutoff value was 7.5% for ΔVpeak, with sensitivity and specificity of 55.6 and 75.0%, respectively.
Conclusions
The carotid artery FTc is a reliable predictor of postinduction hypotension in elderly patients with ASA status of I or II, without cardiovascular disease, hypertension, diabetes, or obesity. Elderly patients with a carotid artery FTc less than 379.1 ms before anesthesia have a higher risk of postinduction hypotension.
Trial registration
Clinical Trial Registry on August 2nd, 2020 (www.chictr.org.cn; ChiCTR2000035190).
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Chen Y, Liu Z, Fang J, Xie Y, Zhang M, Yang J. Correlation of carotid corrected flow time and respirophasic variation in blood flow peak velocity with stroke volume variation in elderly patients under general anaesthesia. BMC Anesthesiol 2022; 22:246. [PMID: 35927621 PMCID: PMC9351080 DOI: 10.1186/s12871-022-01792-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accurate assessment of volume responsiveness in elderly patients is important as it may reduce the risk of post-operative complications and enhance surgical recovery. This study evaluated the utility of two Doppler ultrasound-derived parameters, the carotid corrected flow time (FTc) and respirophasic variation in carotid artery blood flow peak velocity (ΔVpeak), to predict volume responsiveness in elderly patients under general anaesthesia. METHODS A total of 97 elderly patients undergoing elective abdominal surgery under general anaesthesia were enrolled in this prospective observational study. After entering the operating room, all patients underwent radial artery puncture connected with a LiDCO device to measure stroke volume variation (SVV), and fluid therapy was performed after anaesthesia induction. Patients were classified as responders if SVV ≥ 13% before fluid challenge and nonresponders if SVV < 13%. The FTc, ΔVpeak, SVV and haemodynamic data were measured by ultrasound at baseline (T0) and before (T1) and after (T2) fluid challenge. The correlations between the Doppler ultrasound-derived parameters and SVV were analysed, and the receiver operating characteristic (ROC) curves was computed to characterize both FTc and ΔVpeak as measures of volume responsiveness in elderly patients. RESULTS Forty-one (42.3%) patients were fluid responders. Carotid FTc before fluid challenge was negatively correlated with SVV before fluid challenge (r = -0.77; P < 0.01), and ΔVpeak was positively correlated with SVV (r = 0.72; P < 0.01). FTc and ΔVpeak predicted SVV ≥ 13% after general anaesthesia in elderly patients, with areas under the receiver operating characteristic curves (AUROCs) of 0.811 [95% confidence interval (CI), 0.721-0.900; P < 0.001] and 0.781 (95% CI, 0.686-0.875; P < 0.001), respectively. The optimal cut-off values of FTc and ΔVpeak to predict SVV ≥ 13% were 340.74 ms (sensitivity of 76.8%; specificity of 80.5%) and 11.69% (sensitivity of 78.0%; specificity of 67.9%), respectively. CONCLUSIONS There was a good correlation between carotid artery ultrasound parameters and SVV. FTc predicted fluid responsiveness better than ΔVpeak in elderly patients during general anaesthesia. Further study is needed before these parameters can be recommended for clinical application. TRIAL REGISTRATION www.chictr.org.cn (ChiCTR2000031193); registered 23 March 2020.
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Affiliation(s)
- Yu Chen
- Department of Anaesthesiology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Sciences and Technology of China, Hefei, 230001, Anhui, China
| | - Ziyou Liu
- Department of Anaesthesiology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Sciences and Technology of China, Hefei, 230001, Anhui, China
| | - Jun Fang
- Department of Anaesthesiology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Sciences and Technology of China, Hefei, 230001, Anhui, China
| | - Yanhu Xie
- Department of Anaesthesiology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Sciences and Technology of China, Hefei, 230001, Anhui, China
| | - Min Zhang
- Department of Anaesthesiology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Sciences and Technology of China, Hefei, 230001, Anhui, China
| | - Jia Yang
- Department of Anaesthesiology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Sciences and Technology of China, Hefei, 230001, Anhui, China.
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Wang H, Chen W, Cheng H, Liu C, Yao W, Ding F, Wang Y, Chen Y. VALUE OF CORRECTED FLOW TIME IN COMMON CAROTID ARTERY IN PREDICTING VOLUME RESPONSIVENESS UNDER MECHANICAL VENTILATION. Shock 2022; 58:28-33. [PMID: 35904148 PMCID: PMC9415202 DOI: 10.1097/shk.0000000000001959] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/09/2022] [Accepted: 06/13/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Objective: The present study aimed to investigate whether corrected flow time (FTc) in common carotid artery could predict volume responsiveness under mechanical ventilation and to further explore whether the sensitivity and specificity would be influenced by positive end-expiratory pressure (PEEP). Methods: The first stage of this study included 80 patients from the general surgery department undergoing laparotomy. After induction of general anesthesia, FTc in the common carotid artery was measured when hemodynamic indicators, such as blood pressure, heart rate, and cardiac output (CO), were stabilized. Then, 7 mg/kg (ideal body weight) of hydroxyethyl starch 130/0.4 sodium chloride was rapidly infused from the peripheral venous system. The infusion was completed within 15 minutes, and hemodynamic indicators were measured again immediately to evaluate volume responsiveness. The patients with change rate of CO (ΔCO ≥15%) were categorized into the responsive (R) group, whereas those with ΔCO <15% were categorized into the nonresponsive group (NR) group. In the second stage, 29 patients undergoing laparotomy were included. After induction of general anesthesia, PEEP of 0, 5, and 10 cmH 2 O was applied sequentially. Corrected flow time and hemodynamic indicators were recorded. Then, 7 mg/g of hydroxyethyl starch 130/0.4 sodium chloride was rapidly infused for 15 minutes, after which PEEP of 0, 5, and 10 cmH 2 O was applied sequentially, and the indicators were measured again. The patients with FTc equal to or less than the threshold in the first stage were categorized into the R group, otherwise into the NR group. Results: In the first stage of the study, CO and FTc differed significantly between the 2 groups, before and after volume load ( P < 0.05). Mean arterial pressure in the R group was significantly different, whereas heart rate did not differ before and after fluid infusion. Also, heart rate and mean arterial pressure were not significantly different before and after fluid infusion in the NR group. The area under the receiver operating characteristic curve was 0.786 ± 0.056 (95% confidence interval, 0.676-0.896; P = 0.00) for FTc before infusing volume load for predicting volume responsiveness. In the second stage of the study, PEEP did not have significant effects on FTc ( F2, 56 = 1.930, P = 0.155), whereas volume load had statistically significant effects on FTc ( F1, 28 ) = 9.381, P < 0.05). Moreover, FTc differed significantly different before and after fluid infusion ( P < 0.05). The area under the receiver operating characteristic curve for FTc in predicting volume responsiveness was 0.921, 0.805, and 0.719 when PEEP was 0, 5, and 10 cmH 2 O ( P < 0.05), respectively, and the cutoff value of FTc for diagnosing volume responsiveness was 323.42 milliseconds, 326.69 milliseconds, and 312.03 milliseconds, respectively. Conclusion: Corrected flow time in the common carotid artery can predict volume responsiveness under mechanical ventilation, and the predictive performance is not influenced by PEEP. Clinical Trial Registration Clinical register number: ChicTR2000029519.
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Affiliation(s)
- Hongzhi Wang
- Division of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
| | - Wei Chen
- Division of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
| | - Hao Cheng
- Division of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
| | - Can Liu
- Division of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
| | - WeiDong Yao
- Division of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
| | - Fang Ding
- Division of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
| | - YuLong Wang
- Division of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
| | - Yongquan Chen
- Division of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
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A Wireless Ultrasound Patch Detects Mild-to-Moderate Central Hypovolemia during Lower Body Negative Pressure. J Trauma Acute Care Surg 2022; 93:S35-S40. [PMID: 35594422 PMCID: PMC9323554 DOI: 10.1097/ta.0000000000003698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Can a wireless, wearable Doppler ultrasound detect simulated mild hemorrhage during lower body negative pressure? What is the Doppler Shock Index? Read the recent study performed by Kenny et al. @MayoClinic published in @JTraumAcuteSurg #FOAMed We have developed a wireless, wearable Doppler ultrasound system that continuously measures the common carotid artery Doppler pulse. A novel measure from this device, the Doppler shock index, accurately detected moderate-to-severe central blood volume loss in a human hemorrhage model generated by lower body negative pressure. In this analysis, we tested whether the wearable Doppler could identify only mild-to-moderate central blood volume loss.
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Anand R, Chowdhury S, Baidya D, Maitra S, Singh A, Rewari V. Assessment of role of inferior vena cava collapsibility index and variations in carotid artery peak systolic velocity in prediction of post-spinal anaesthesia hypotension in spontaneously breathing patients: An observational study. Indian J Anaesth 2022; 66:100-106. [PMID: 35359469 PMCID: PMC8963237 DOI: 10.4103/ija.ija_828_21] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/11/2021] [Accepted: 02/06/2022] [Indexed: 11/04/2022] Open
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Kenny JÉS. Functional Hemodynamic Monitoring With a Wireless Ultrasound Patch. J Cardiothorac Vasc Anesth 2021; 35:1509-1515. [PMID: 33597088 DOI: 10.1053/j.jvca.2021.01.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 01/19/2021] [Indexed: 02/07/2023]
Abstract
In this Emerging Technology Review, a novel, wireless, wearable Doppler ultrasound patch is described as a tool for resuscitation. The device is designed, foremost, as a functional hemodynamic monitor-a simple, fast, and consistent method for measuring hemodynamic change with preload variation. More generally, functional hemodynamic monitoring is a paradigm that helps predict stroke volume response to additional intravenous volume. Because Doppler ultrasound of the left ventricular outflow tract noninvasively measures stroke volume in realtime, it increasingly is deployed for this purpose. Nevertheless, Doppler ultrasound in this manner is cumbersome, especially when repeat assessments are needed. Accordingly, peripheral arteries have been studied and various measures from the common carotid artery Doppler signal act as windows to the left ventricle. Yet, handheld Doppler ultrasound of a peripheral artery is susceptible to human measurement error and statistical limitations from inadequate beat sample size. Therefore, a wearable Doppler ultrasound capable of continuous assessment minimizes measurement inconsistencies and smooths inherent physiologic variation by sampling many more cardiac cycles. Reaffirming clinical studies, the ultrasound patch tracks immediate SV change with excellent accuracy in healthy volunteers when cardiac preload is altered by various maneuvers. The wearable ultrasound also follows jugular venous Doppler, which qualitatively trends right atrial pressure. With further clinical research and the application of artificial intelligence, the monitoring modalities with this new technology are manifold.
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