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de Boer EC, Dinis Fernandes C, van Neerven D, Pennings C, Joshi R, Manzari S, Shulepov S, van Knippenberg L, van Rooij J, Bouwman RA, Mischi M. Quantitative assessment of carotid ultrasound diameter measurements in the operating room: a comparable analysis of long-axis versus rotated and tilted orientation. Physiol Meas 2024; 45:035006. [PMID: 38422517 DOI: 10.1088/1361-6579/ad2eb4] [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: 06/29/2023] [Accepted: 02/29/2024] [Indexed: 03/02/2024]
Abstract
Objective. Carotid ultrasound (US) has been studied as a non-invasive alternative for hemodynamic monitoring. A long-axis (LA) view is traditionally employed but is difficult to maintain and operator experience may impact the diameter estimates, making it unsuitable for monitoring. Preliminary results show that a new, i.e. rotated and tilted (RT) view is more robust to motion and less operator-dependent. This study aimed to quantitatively assess common carotid diameter estimates obtained in a clinical setting from an RT view and compare those to corresponding estimates obtained using other views.Approach. Carotid US measurements were performed in 30 adult cardiac-surgery patients (26 males, 4 females) with short-axis (SA), LA, and RT probe orientations, the first being used as a reference for measuring the true vessel diameter. Per 30 s acquisition, the median and spread in diameter values were computed, the latter representing a measure of robustness, and were statistically compared between views.Main results. The median (IQR) over all the patients of the median diameter per 30 s acquisition was 7.15 (1.15) mm for the SA view, 7.03 (1.51) mm for the LA view, and 6.99 (1.72) mm for the RT view. The median spread in diameter values was 0.18 mm for the SA view, 0.16 mm for the LA view, and 0.18 mm for the RT view. There were no statistically significant differences between views in the median diameter values (p= 0.088) or spread (p= 0.122).Significance. The RT view results in comparable and equally robust median carotid diameter values compared to the reference. These findings open the path for future studies investigating the use of the RT view in new applications, such as in wearable ultrasound devices.
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Affiliation(s)
- Esmée C de Boer
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Catarina Dinis Fernandes
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Danihel van Neerven
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Christoph Pennings
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rohan Joshi
- Philips Research, Eindhoven, The Netherlands
| | | | | | - Luuk van Knippenberg
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Philips Research, Eindhoven, The Netherlands
| | | | - R Arthur Bouwman
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Anesthesiology and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Massimo Mischi
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Kenny JES. The left ventricular outflow tract and carotid artery velocity time integrals. FRONTIERS IN MEDICAL TECHNOLOGY 2024; 6:1320810. [PMID: 38333734 PMCID: PMC10847292 DOI: 10.3389/fmedt.2024.1320810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/15/2024] [Indexed: 02/10/2024] Open
Abstract
The left ventricular outflow tract velocity time integral (LVOT VTI) is commonly used in the intensive care unit as a measure of stroke volume (SV) and how the SV changes in response to an intervention; therefore, the LVOT VTI is used to guide intravenous fluid management. Various peripheral Doppler surrogates are proposed to infer the LVOT VTI (e.g., measures from the common carotid artery). A recently-described, novel method of insonation has an excellent ability to detect change in the LVOT VTI. This approach raises important facets of Doppler flow and insonation error, as well as the general principles at play when using a peripheral artery to infer changes from the left ventricle. Relating the VTI of a peripheral artery to the LVOT VTI was recently described mathematically and may help clinicians think about the Doppler relationship between central and peripheral flow.
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Affiliation(s)
- Jon-Emile S. Kenny
- Health Sciences North Research Institute, Sudbury, ON, Canada
- Flosonics Medical, Toronto, ON, Canada
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3
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Dai S, Wang C, Tao X, Shen J, Xu L. Predicting fluid responsiveness in spontaneously breathing parturients undergoing caesarean section via carotid artery blood flow and velocity time integral measured by carotid ultrasound: a prospective cohort study. BMC Pregnancy Childbirth 2024; 24:60. [PMID: 38216901 PMCID: PMC10785346 DOI: 10.1186/s12884-024-06246-z] [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: 06/05/2023] [Accepted: 01/01/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Present evidence suggests that the Doppler ultrasonographic indices, such as carotid artery blood flow (CABF) and velocity time integral (VTI), had the ability to predict fluid responsiveness in non-obstetric patients. The purpose of this study was to assess their capacity to predict fluid responsiveness in spontaneous breathing parturients undergoing caesarean section and to determine the effect of detecting and management of hypovolemia (fluid responsiveness) on the incidence of hypotension after anaesthesia. METHODS A total of 72 full term singleton parturients undergoing elective caesarean section were enrolled in this study. CABF, VTI, and hemodynamic parameters were recorded before and after fluid challenge and assessed by carotid artery ultrasonography. Fluid responsiveness was defined as an increase in stroke volume index (SVI) of 15% or more after the fluid challenge. RESULTS Thirty-one (43%) patients were fluid responders. The area under the ROC curve to predict fluid responsiveness for CABF and VTI were 0.803 (95% CI, 0.701-0.905) and 0.821 (95% CI, 0.720-0.922). The optimal cut-off values of CABF and VTI for fluid responsiveness was 175.9 ml/min (sensitivity of 74.0%; specificity of 78.0%) and 8.7 cm/s (sensitivity of 67.0%; specificity of 90.0%). The grey zone for CABF and VTI were 114.2-175.9 ml/min and 6.8-8.7 cm/s. The incidence of hypotension after the combined spinal-epidural anaesthesia (CSEA) was significantly higher in the Responders group 25.8% (8/31) than in the Non-Responders group 17.1(7/41) (P < 0.001). The total incidence of hypotension after CSEA of the two groups was 20.8% (15/72). CONCLUSIONS Ultrasound evaluation of CABF and VTI seem to be the feasible parameters to predict fluid responsiveness in parturients undergoing elective caesarean section and detecting and management of hypovolemia (fluid responsiveness) could significantly decrease incidence of hypotension after anaesthesia. TRIAL REGISTRATION The trial was registered at the Chinese Clinical Trial Registry (ChiCTR) ( www.chictr.org ), registration number was ChiCTR1900022327 (The website link: https://www.chictr.org.cn/showproj.html?proj=37271 ) and the date of trial registration was in April 5, 2019. This study was performed in accordance with the Declaration of Helsinki and approved by the Research Ethics Committee of Women's Hospital, Zhejiang University School of Medicine (20,180,120).
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Affiliation(s)
- Shaobing Dai
- Department of Anaesthesiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Chun Wang
- Department of Anaesthesiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Xia Tao
- Department of Ultrasound, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Jianjun Shen
- Department of Anaesthesiology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Lili Xu
- Department of Anaesthesiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, Zhejiang Province, China.
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Karmarkar A, Pal D, Govil D, Patel SJ, Kn J, Harne R, Pachisia AV, Tyagi P, Reddy DM, Brar K. Carotid Blood Flow as a Surrogate for Pulse Contour Analysis in Assessment of Fluid Responsiveness: A Prospective, Observational, Single-Centre Study (Contour Study). Cureus 2024; 16:e53253. [PMID: 38435954 PMCID: PMC10904354 DOI: 10.7759/cureus.53253] [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] [Accepted: 01/30/2024] [Indexed: 03/05/2024] Open
Abstract
Background and objectives The quest for an accurate and reliable non-invasive method of assessing cardiac output in critically ill patients is still ongoing. Carotid artery Doppler is a promising non-invasive, reproducible, and feasible bedside monitor. So we compared the change in cardiac output derived from arterial pressure waveforms (pulse contour analysis) with that from carotid artery Doppler-derived measurements, in post-major elective abdominal surgery patients. Materials and methods We conducted a prospective observational study in 30 adult post-major elective abdominal surgery patients admitted to the Gastroenterology and Liver Transplant intensive care unit postoperatively on mechanical ventilator support, who were found to be fluid responsive clinically on passive leg raise (PLR) test. Demographics and vasopressor support were recorded. Hemodynamic parameters including heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), cardiac output (CO) using arterial pulse contour analysis (Vigileo monitor/FloTrac® sensor; Edwards Lifesciences, Irvine, California, United States), and carotid blood flow (CBF) were recorded on the baseline, pre- and post- PLR, and post fluid bolus administration. Balanced salt solution at the rate of 6ml/kg over 20 minutes was given as a fluid bolus. Results Of the 30 patients who were included in the study, 16 patients (53.3%) were on vasopressor support, mean (± SD) age of the patients was 52.93 (± 8.13) years. There was a significant increase in the SBP (mmHg) pre- to post-PLR, that is, 112.2±15.57 and 118.7±14.96, respectively (p-value = 0.001). Also from pre-PLR to post-fluid bolus administration, the increase in SBP was significant, 112.2±15.57 and 121.93±13.96, respectively (p-value = 0.001). The change in cardiac output measured using Vigileo and CBF from pre- to post-PLR (7.66±1.45 to 9.14±1.76, p< 0.001 for Vigileo and 8.10±1.66 to 9.72±1.99, p<0.001 for CBF) and pre-PLR to post fluid administration (7.66±1.45 to 9.39±1.77, p< 0.001 for Vigileo and 8.10±1.66 to 10.31±2.26, p< 0.001 for CBF) were significant. There was a positive correlation between the change in cardiac output as measured from arterial pulse contour analysis technique (Vigileo) and that measured from CBF (r=0.884) pre- and post-PLR. There was a significant correlation between cardiac output measurements derived from two techniques, before PLR, after PLR, and after fluid expansion (p< 0.001 for each variable). The change in cardiac output before PLR and after fluid expansion was also correlated by both the techniques (correlation coefficient being, r=0.781). Conclusion There was a significant positive correlation of the CO (absolute and change) measurements pre- and post-interventions (that is, PLR and fluid bolus administration) as made by pulse contour analysis (Vigileo) and by CBF in post-surgical patients. Pulse wave Doppler of CBF could be used as a surrogate for invasive measures of CO measurement for prediction of fluid responsiveness in this subgroup. Further larger studies can be performed to validate the same.
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Affiliation(s)
- Anirban Karmarkar
- Critical Care Medicine, Medica Superspeciality Hospital, Kolkata, IND
| | - Divya Pal
- Anaesthesiology and Critical Care Medicine, Medanta-The Medicity, Gurugram, IND
| | - Deepak Govil
- Anaesthesiology and Critical Care Medicine, Medanta-The Medicity, Gurugram, IND
| | - Sweta J Patel
- Anaesthesiology and Critical Care Medicine, Medanta-The Medicity, Gurugram, IND
| | - Jagadeesh Kn
- Anaesthesiology and Critical Care Medicine, Medanta-The Medicity, Gurugram, IND
| | - Rahul Harne
- Anaesthesiology and Critical Care Medicine, Medanta-The Medicity, Gurugram, IND
| | | | - Pooja Tyagi
- Anaesthesiology and Critical Care Medicine, Medanta-The Medicity, Gurugram, IND
| | | | - Keerti Brar
- Critical Care Medicine, Medanta-The Medicity, Gurugram, IND
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5
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Patnaik R, Krishna B, Sampath S. Correlation of Common Carotid Artery Blood Flow Parameters With Transthoracic Echocardiographic Cardiac Output for Assessing Fluid Responsiveness After Passive Leg Raising (PLR) Test in Critically Ill Patients. Cureus 2023; 15:e40229. [PMID: 37435241 PMCID: PMC10332793 DOI: 10.7759/cureus.40229] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 07/13/2023] Open
Abstract
Introduction The passive leg raising (PLR) test is a simple, non-invasive method of knowing fluid responsiveness by acting as an internal-fluid challenge. The PLR test coupled with a non-invasive assessment of stroke volume would be the ideal method to assess fluid responsiveness. This study aimed to determine the correlation between transthoracic echocardiographic cardiac output (TTE-CO) and common carotid artery blood flow (CCABF) parameters in determining fluid responsiveness with the PLR test. Methods We performed a prospective observational study on 40 critically ill patients. Patients were evaluated with a 7-13 MHz linear transducer probe for CCABF parameters calculated using time-averaged mean velocity (TAmean) and with a 1-5 MHz cardiac probe equipped with tissue doppler imaging (TDI) for TTE-CO calculated using left ventricular outflow tract velocity time integral (LVOT VTI) with an apical five-chamber view. Two separate PLR tests (five minutes apart) were done within 48 hours of ICU admission. The first PLR test was to assess the effects on TTE-CO. The second PLR test was performed to assess the effects on CCABF parameters. Patients were designated as fluid responders (FR) if changes in TTE-CO (Δ TTE-CO) ≥ 10 %. Results A positive PLR test was observed in 33% of patients. A strong correlation was present between absolute values of TTE-CO calculated using LVOT VTI and the absolute values of CCABF calculated using TAmean (r=0.60, p<0.05). However, a weak correlation was found between Δ TTE-CO and changes in CCABF (Δ CCABF) during the PLR test (r=0.05, p<0.74). A positive PLR test response could not be detected by Δ CCABF (area under the curve (AUC): 0.59 ± 0.09). Conclusions We found a moderate correlation between TTE-CO and CCABF at baseline. However, Δ TTE-CO had a very poor correlation with Δ CCABF, during the PLR test. Considering this, CCABF parameters may not be recommended as a means to detect fluid responsiveness with PLR tests in critically ill patients.
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Affiliation(s)
- Rohit Patnaik
- Critical Care Medicine, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND
| | - Bhuvana Krishna
- Critical Care Medicine, St. John's Medical College and Hospital, Bengaluru, IND
| | - Sriram Sampath
- Critical Care Medicine, St. John's Medical College and Hospital, Bengaluru, IND
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Blanca D, Schwarz EC, Olgers TJ, Ter Avest E, Azizi N, Bouma HR, Ter Maaten JC. Intra-and inter-observer variability of point of care ultrasound measurements to evaluate hemodynamic parameters in healthy volunteers. Ultrasound J 2023; 15:22. [PMID: 37145390 PMCID: PMC10163179 DOI: 10.1186/s13089-023-00322-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/13/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is a valuable tool for assessing the hemodynamic status of acute patients. Even though POCUS often uses a qualitative approach, quantitative measurements have potential advantages in evaluating hemodynamic status. Several quantitative ultrasound parameters can be used to assess the hemodynamic status and cardiac function. However, only limited data on the feasibility and reliability of the quantitative hemodynamic measurements in the point-of-care setting are available. This study investigated the intra- and inter-observer variability of PoCUS measurements of quantitative hemodynamic parameters in healthy volunteers. METHODS In this prospective observational study, three sonographers performed three repeated measurements of eight different hemodynamic parameters in healthy subjects. An expert panel of two experienced sonographers evaluated the images' quality. The repeatability (intra-observer variability) was determined by calculating the coefficient of variation (CV) between the separate measurements for each observer. The reproducibility (inter-observer variability) was assessed by determining the intra-class correlation coefficient (ICC). RESULTS 32 subjects were included in this study, on whom, in total, 1502 images were obtained for analysis. All parameters were in a normal physiological range. Stroke volume (SV), cardiac output (CO), and inferior vena cava diameter (IVC-D) showed high repeatability (CV under 10%) and substantial reproducibility (ICC 0.61-0.80). The other parameters had only moderate repeatability and reproducibility. CONCLUSIONS We demonstrated good inter-observer reproducibility and good intra-observer repeatability for CO, SV and IVC-D taken in healthy subjects by emergency care physicians.
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Affiliation(s)
- Deborah Blanca
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- Department of Internal Medicine, Ospedale Maggiore Policlinico, Università Degli Studi di Milano, Milan, Italy.
| | - Esther C Schwarz
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tycho Joan Olgers
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ewoud Ter Avest
- Department of Emergency Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Nasim Azizi
- Department of Emergency Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Hjalmar R Bouma
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan Cornelis Ter Maaten
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Suriani I, van Houte J, de Boer EC, van Knippenberg L, Manzari S, Mischi M, Bouwman RA. Carotid Doppler ultrasound for non-invasive haemodynamic monitoring: a narrative review. Physiol Meas 2023; 43. [PMID: 36179705 DOI: 10.1088/1361-6579/ac96cb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/30/2022] [Indexed: 11/11/2022]
Abstract
Objective.Accurate haemodynamic monitoring is the cornerstone in the management of critically ill patients. It guides the optimization of tissue and organ perfusion in order to prevent multiple organ failure. In the past decades, carotid Doppler ultrasound (CDU) has been explored as a non-invasive alternative for long-established invasive haemodynamic monitoring techniques. Considering the large heterogeneity in reported studies, we conducted a review of the literature to clarify the current status of CDU as a haemodynamic monitoring tool.Approach.In this article, firstly an overview is given of the equipment and workflow required to perform a CDU exam in clinical practice, the limitations and technical challenges potentially faced by the CDU sonographer, and the cerebrovascular mechanisms that may influence CDU measurement outcomes. The following chapter describes alternative techniques for non-invasive haemodynamic monitoring, detailing advantages and limitations compared to CDU. Next, a comprehensive review of the literature regarding the use of CDU for haemodynamic monitoring is presented. Furthermore, feasibility aspects, training requirements and technical developments of CDU are addressed.Main results.Based on the outcomes of these studies, we assess the applicability of CDU-derived parameters within three clinical domains (cardiac output, volume status, and fluid responsiveness), and amongst different patient groups. Finally, recommendations are provided to improve the quality and standardization of future research and clinical practice in this field.Significance.Although CDU is not yet interchangeable with invasive 'gold standard' cardiac output monitoring, the present work shows that certain CDU-derived parameters prove promising in the context of functional haemodynamic monitoring.
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Affiliation(s)
- Irene Suriani
- Eindhoven University of Technology, Groene Loper 3, 5612 AE Eindhoven, The Netherlands
| | - Joris van Houte
- Catharina Hospital Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
| | - Esmée C de Boer
- Eindhoven University of Technology, Groene Loper 3, 5612 AE Eindhoven, The Netherlands
| | - Luuk van Knippenberg
- Eindhoven University of Technology, Groene Loper 3, 5612 AE Eindhoven, The Netherlands
| | - Sabina Manzari
- Philips Research High Tech Campus 34, 5656 AE Eindhoven, The Netherlands
| | - Massimo Mischi
- Eindhoven University of Technology, Groene Loper 3, 5612 AE Eindhoven, The Netherlands
| | - R Arthur Bouwman
- Eindhoven University of Technology, Groene Loper 3, 5612 AE Eindhoven, The Netherlands.,Catharina Hospital Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
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8
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Kenny JES. A theoretical foundation for relating the velocity time integrals of the left ventricular outflow tract and common carotid artery. J Clin Monit Comput 2023; 37:937-939. [PMID: 36625983 PMCID: PMC10175385 DOI: 10.1007/s10877-022-00969-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Jon-Emile S Kenny
- Health Sciences North Research Institute, 56 Walford Rd, Sudbury, ON, P3E 2H2, Canada. .,Flosonics Medical, Toronto, ON, Canada.
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9
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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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Carotid Doppler Ultrasonography for Hemodynamic Assessment in Critically Ill Children. Pediatr Cardiol 2022; 43:382-390. [PMID: 34518914 DOI: 10.1007/s00246-021-02732-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
An accurate assessment of cardiovascular performance is essential to predict and evaluate hemodynamic response to interventions. The objective of this prospective study was to assess whether point-of-care ultrasonography of the common carotid artery (CCA) can estimate the stroke volume (SV) and cardiac index (Ci) of critically ill children. Participants underwent Doppler ultrasonography of the left CCA and transthoracic echocardiography (TTE). Variables measured by TTE were SV and Ci. Carotid blood flow (CBF) was calculated based on both systolic velocity-time integral (CBF(s)) and total velocity-time integral (CBF(t)). Carotid corrected flow time(CFT)was also determined. A total of 50 children were enrolled. The median age and weight of participants were 36.0 months and 14.2 kg, respectively. Both CBF(s) and CBF(t) correlated very strongly with SV (ρ = 0.98 and 0.97, respectively) and Ci (ρ = 0.96 and 0.92, respectively). Agreement analysis showed low biases and clinically acceptable percentage errors between variables measured by TTE (SV and Ci) and those estimated by Doppler ultrasonography. Linear regression analysis revealed that the Ci of mechanically ventilated children can be estimated by the following equation: [Formula: see text]. CFT did not significantly correlate with SV or Ci (ρ = 0.27 and 0.05, respectively). Doppler ultrasonography of the left CCA is able to estimate the SV and Ci of critically ill children. Therefore, the CDU may be considered as an alternative for estimating Ci in critically ill children when TTE is not feasible or available.
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Suriani I, Bouwman RA, Mischi M, Lau KD. Validation of an aging virtual population for the study of carotid hemodynamics. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:4249-4252. [PMID: 34892161 DOI: 10.1109/embc46164.2021.9630876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The analysis of carotid ultrasound (US) flow, velocity, and diameter waveforms provides important information about cardiovascular and circulatory health. These can be used to derive clinical indices of atherosclerosis, vascular aging, and hemodynamic status. To derive clinical insight from carotid waveforms, it is essential to understand the relationship of the observed variability in morphology with the underlying hemodynamic status and cardiovascular properties. For this purpose, using a one-dimensional modeling approach, we have developed and validated a virtual population that is able to realistically simulate carotid waveforms of healthy subjects aged between 10 and 80 years old.Clinical Relevance-Our virtual population of carotid waveforms can support the interpretation of US patient data. It can be used, e.g., to investigate how waveform morphology and derived indices relate to individual arterial and cardiac properties.
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van Houte J, Mooi FJ, Montenij LJ, Meijs LPB, Suriani I, Conjaerts BCM, Houterman S, Bouwman AR. Correlation of Carotid Doppler Blood Flow With Invasive Cardiac Output Measurements in Cardiac Surgery Patients. J Cardiothorac Vasc Anesth 2021; 36:1081-1091. [PMID: 34756675 DOI: 10.1053/j.jvca.2021.09.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Carotid Doppler ultrasound has been a topic of recent interest, as it may be a promising noninvasive hemodynamic monitoring tool. In this study, the relation between carotid artery blood flow and invasive cardiac output (CO) was evaluated. DESIGN A prospective, observational study. SETTING A single-institution, tertiary referral hospital. PARTICIPANTS Eighteen elective cardiac surgery patients. INTERVENTIONS CO was measured by calibrated pulse contour analysis. Simultaneously, carotid artery pulsed-wave Doppler measurements were obtained in the operating room in three clinical settings: after induction of anesthesia (T1), after a passive leg raise maneuverer (T2), and at the end of surgery (T3). MEASUREMENTS AND MAIN RESULTS Correlation and trending between carotid artery blood flow and invasive CO were evaluated. Furthermore, two Bland-Altman plots were constructed to evaluate the level of agreement between carotid artery-derived CO and invasive CO measurements. Carotid artery blood flow correlated moderately with invasive CO (ρ = 0.67, 95% confidence interval 0.56-0.76, p < 0.05). Concordance between the percentage change of carotid artery blood flow and invasive CO from T1 to T3 was 72%. The level of agreement between carotid artery-derived CO and invasive CO was ±2.29; ±2.57 L/min, with a bias of 0.1; -0.54 L/min, and mean error of 50% and 48%, for the two Bland-Altman analyses, respectively. Intraexamination precision was acceptable. CONCLUSIONS In cardiac surgery patients, carotid artery blood flow correlated moderately with invasive CO measurements. However, the trending ability of carotid artery blood flow was poor, and carotid artery-derived CO tended not to be interchangeable with invasive CO.
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Affiliation(s)
- Joris van Houte
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands; Department of Intensive Care, Catharina Hospital, Eindhoven, The Netherlands.
| | - Frederik J Mooi
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Leon J Montenij
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands; Department of Intensive Care, Catharina Hospital, Eindhoven, The Netherlands
| | - Loek P B Meijs
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Irene Suriani
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Bente C M Conjaerts
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Saskia Houterman
- Department of Education and Research, Catharina Hospital, Eindhoven, The Netherlands
| | - Arthur R Bouwman
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands
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The effect of norepinephrine on common carotid artery blood flow in septic shock patients. Sci Rep 2021; 11:16763. [PMID: 34408193 PMCID: PMC8373863 DOI: 10.1038/s41598-021-96082-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/04/2021] [Indexed: 11/17/2022] Open
Abstract
This study was designed to evaluate the hemodynamic effect of norepinephrine (NE) on the peak systolic velocity (PSV), diameter, and blood flow of the common carotid artery (CCA) using the point-of-care ultrasound (POCUS) in patients with septic shock. The study involved patients above 18 years old with septic shock. Arterial monitoring, carotid ultrasonography, and transthoracic echocardiography were performed before NE administration (T0). When the mean arterial pressure exceeded 65 mmHg after NE administration (T1), the measurement was repeated. Twenty-four patients (median age 67 [interquartile range: 54–77] years; 42% female) with septic shock were examined in this study. Before (T0) and after (T1) NE administration, the PSV (mean, standard deviation [SD]) changed from 85.3 (21.1) cm/s to 83.5 (23.5) cm/s (p = 0.417); this change was not significant. However, the diameter and blood flow of the CCA increased significantly from 0.6 (0.09) cm and 0.75 (0.27) L/min to 0.66 (0.09) cm and 0.85 (0.27) L/min, respectively (p < 0.001). The diameter of the left ventricular outflow tract (LVOT) remained unchanged, but the velocity time integral of the LVOT increased significantly from 21.7 (4.39) cm to 23.6 (5.14) cm. There was no significant correlation between changes in blood flow of the CCA and changes in cardiac output (coefficient −0.365, p = 0.079). In conclusion, NE increased the diameter and blood flow of the CCA significantly, without changing the PSV in patients with septic shock.
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Mamdouh F, Bazaraa H, Baz A, Algebaly HF. Prognostic value of baseline carotid blood flow in critically ill children with septic shock. PLoS One 2021; 16:e0251154. [PMID: 34298550 PMCID: PMC8302249 DOI: 10.1371/journal.pone.0251154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 04/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background and aim Hemodynamic monitoring and cardiac output (CO) assessment in the ICU have been trending toward less invasive methods. Carotid blood flow (CBF) was suggested as a candidate for CO assessment. The present study aimed to test the value of carotid artery ultrasound analysis in prediction of mortality in pediatric patients with septic shock. Methodology/Principal finding Forty children with septic shock were included in the study. Upon admission, patients were subjected to careful history taking and thorough clinical examination. The consciousness level was assessed by the Glasgow Coma Scale (GCS). Laboratory assessment included complete blood count, C-reactive protein, arterial blood gases, serum electrolytes, and liver and kidney function tests. Electrical cardiometry was used to evaluate hemodynamic parameters. Patients were also subjected to transthoracic 2-D echocardiography. CBF was evaluated using GE Vivid S5 ultrasound device through dedicated software. At the end of study, 14 patients (35.0%) died. It was found that survivors had significantly higher CBF when compared non-survivors [median (IQR): 166.0 (150.0–187.3) versus 141.0 (112.8–174.3), p = 0.033]. In addition, it was noted that survivors had longer ICU stay when compared with non-survivors [16.5 (9.8–31.5) versus 6.5 (3.0–19.5) days, p = 0.005]. ROC curve analysis showed that CBF could significantly distinguish survivors from non-survivors [AUC (95% CI): 0.3 (0.11–0.48), p = 0.035] (Fig 2). Univariate logistic regression analysis identified type of shock [OR (95% CI): 28.1 (4.9–162.4), p<0.001], CI [OR (95% CI): 0.6 (0.43–0.84), p = 0.003] and CBF [OR (95% CI): 0.98 (0.96–0.99), p = 0.031]. However, in multivariate analysis, only type of shock significantly predicted mortality. Conclusions CBF assessment may be a useful prognostic marker in children with septic shock.
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Affiliation(s)
- Fatma Mamdouh
- Department of Critical Care, Specialized Children Hospital, Cairo University, Cairo, Egypt
- Department of Pediatric, Specialized Children Hospital, Cairo University, Cairo, Egypt
| | - Hafez Bazaraa
- Department of Critical Care, Specialized Children Hospital, Cairo University, Cairo, Egypt
- Department of Pediatric, Specialized Children Hospital, Cairo University, Cairo, Egypt
| | - Ahmed Baz
- Department of Radiology, Kasr Al Aini Hospital, Cairo University, Cairo, Egypt
| | - HebatAllah Fadel Algebaly
- Department of Critical Care, Specialized Children Hospital, Cairo University, Cairo, Egypt
- Department of Pediatric, Specialized Children Hospital, Cairo University, Cairo, Egypt
- * E-mail:
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15
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Hill EC, Housh TJ, Smith CM, Keller JL, Anders JPV, Schmidt RJ, Johnson GO. Acute changes in muscle thickness, edema, and blood flow are not different between low-load blood flow restriction and non-blood flow restriction. Clin Physiol Funct Imaging 2021; 41:452-460. [PMID: 34192417 DOI: 10.1111/cpf.12720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/05/2021] [Accepted: 06/22/2021] [Indexed: 11/28/2022]
Abstract
The purpose of the present study was to examine the acute changes in muscle swelling (as assessed by muscle thickness and echo intensity) and muscle blood flow associated with an acute bout of low-load blood flow restriction (LLBFR) and low-load non-blood flow restriction (LL) exercise. Twenty women (mean ± SD; 22 ± 2years) volunteered to perform an acute exercise bout that consisted of 75 (1 × 30, 3 × 15) isokinetic, reciprocal, concentric-only, submaximal (30% of peak torque), forearm flexion and extension muscle actions. Pretest, immediately after (posttest), and 5-min after (recovery) completing the 75 repetitions, muscle thickness and echo intensity were assessed from the biceps brachii and triceps brachii muscles and muscle blood flow was assessed from the brachial artery. There were no between group differences for any of the dependent variables, but there were significant simple and main effects for muscle and time. Biceps and triceps brachii muscle thickness increased from pretest (2.13 ± 0.39 cm and 1.88 ± 0.40 cm, respectively) to posttest (2.58 ± 0.49 cm and 2.17 ± 0.43 cm, respectively) for both muscles and remained elevated for the biceps brachii (2.53 ± 0.43 cm), but partially returned to pretest levels for the triceps brachii (2.06 ± 0.41 cm). Echo intensity and muscle blood flow increased from pretest (98.0 ± 13.6 Au and 94.5 ± 31.6 ml min-1 , respectively) to posttest (109.2 ± 16.9 Au and 312.2 ± 106.5 ml min-1 , respectively) and pretest to recovery (110.1 ± 18.3 Au and 206.7 ± 92.9 ml min-1 , respectively) and remained elevated for echo intensity, but partially returned to pretest levels for muscle blood flow. The findings of the present study indicated that LLBFR and LL elicited comparable acute responses as a result of reciprocal, concentric-only, forearm flexion and extension muscle actions.
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Affiliation(s)
- Ethan C Hill
- School of Kinesiology & Physical Therapy, Division of Kinesiology, University of Central Florida, Orlando, FL, USA.,Florida Space Institute, University of Central Florida, Orlando, FL, USA
| | - Terry J Housh
- Department of Nutrition and Health Sciences, Human Performance Laboratory, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Cory M Smith
- College of Health Sciences, Department of Kinesiology, University of Texas at El Paso, El Paso, TX, USA
| | - Joshua L Keller
- College of Education and Professional Studies, Department of Health, Kinesiology and Sport, University of South Alabama, Mobile, AL, USA
| | - John Paul V Anders
- Department of Nutrition and Health Sciences, Human Performance Laboratory, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Richard J Schmidt
- Department of Nutrition and Health Sciences, Human Performance Laboratory, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Glen O Johnson
- Department of Nutrition and Health Sciences, Human Performance Laboratory, University of Nebraska-Lincoln, Lincoln, NE, USA
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16
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Devia Jaramillo G, Menendez Ramirez S. USER Protocol as a Guide to Resuscitation of the Patient with Septic Shock in the Emergency Department. Open Access Emerg Med 2021; 13:33-43. [PMID: 33603505 PMCID: PMC7886247 DOI: 10.2147/oaem.s289148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/14/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Sepsis is a disease that is still associated with high mortality, in which timely interventions are related to better results. Objective To determine if there is a difference in in-hospital mortality, fluid balances, norepinephrine initiation and recovery time of blood pressure, when comparing the resuscitation of the patient who is admitted to the emergency room in septic shock by applying the ultrasound protocol (USER) versus the standard of care. Patients and Methods This is a prospective, cohort study conducted in the emergency room of a highly complex hospital of patients with septic shock. Results 83 patients recruited in total. The groups were comparable in demographics, mean baseline blood pressure, disease severity given by the SOFA value, and arterial lactate. A statistically significant difference was documented in the fluid balances at 4 hours, median 1325mL (IQR:451–2455mL) in Group C versus 900mL (IQR:440–1292) in Group U (p=0.048) and at 6 hours, median 1658mL (IQR:610–2925mL) versus 1107mL (IQR:600–1500mL), p=0.026, as well as in the total fluid balance of hospital stay, median 14,564mL (IQR:8660–18,705mL) versus 8660mL (IQR:5309–16,974mL), p=0.049. On the other hand, in the USER Group, the mean blood pressure ≥ 65mmHg was achieved in 97.4% of the patients 4 hours after the start of the protocol versus 50% in Group C (p=<0.001). Mortality with the use of the protocol compared with conventional therapy was (56.4% vs 61.36%, p=0.647). Conclusion The use of the USER protocol in patients with septic shock in the emergency room showed lower fluid balances at 4 and 6 hours, and of the total hospital stay, as well as earlier initiation of norepinephrine and statistically significant faster improvement in blood pressure. Although a statistically significant difference was not found in the days of ICU stay, hospitalization and in-hospital mortality, a trend was observed in the reduction of these parameters.
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Affiliation(s)
- German Devia Jaramillo
- Resuscitation Unit, Hospital Universitario Mayor Méderi; Department of Emergency Medicine-Internal Medicine, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Salvador Menendez Ramirez
- Department of Emergency Medicine, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
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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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18
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Hill EC, Housh TJ, Smith CM, Keller JL, Schmidt RJ, Johnson GO. High- vs. Low-Intensity Fatiguing Eccentric Exercise on Muscle Thickness, Strength, and Blood Flow. J Strength Cond Res 2021; 35:33-40. [DOI: 10.1519/jsc.0000000000002632] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Kenny JS, Barjaktarevic I, Eibl AM, Parrotta M, Long BF, Eibl JK. A wearable carotid Doppler tracks changes in the descending aorta and stroke volume induced by end-inspiratory and end-expiratory occlusion: A pilot study. Health Sci Rep 2020; 3:e190. [PMID: 33033751 PMCID: PMC7534617 DOI: 10.1002/hsr2.190] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/28/2020] [Accepted: 08/18/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND AIMS To test the feasibility of a novel, wearable carotid Doppler ultrasound to track changes in cardiac output induced by end-inspiratory and end-expiratory occlusion tests. METHODS We observed the pattern of Doppler change of the common carotid artery during a simulated end-inspiratory and expiratory occlusion test (sEIOT/sEEOT) in 10, nonventilated, healthy subjects. Simultaneously, we measured the Doppler signal of the descending aorta using duplex ultrasound (Xario, Toshiba Medical Systems) and stroke volume (SV) using noninvasive pulse contour analysis (Clearsight, Edwards Lifesciences, Irvine, California). RESULTS During sEIOT, SV, maximum velocity time integral (VTI) of the descending aorta, and common carotid fell by 25.7% (P = .0131), 26.1% (P < .0001), and 18.5% (P < .0001), respectively. During sEEOT, SV, maximum VTI of the descending aorta, and common carotid rose by: 41.3% (P = .0051), 28.3% (P < .0001), and 41.6% (P < .0001), respectively. There was good correlation between change in aortic VTI and carotid VTI (r 2 = 0.79); SV and aortic VTI (r 2 = 0.82), and SV and carotid VTI (r 2 = 0.95).The coefficient of variation of the VTI measured by the Doppler patch was roughly 60% less than that of the duplex system. CONCLUSIONS The pattern of SV change induced by a sEIOT/sEEOT in nonmechanically ventilated volunteers is reflected in the common carotid artery and descending aorta. The VTI variability of the Doppler patch was less than that of the traditional, duplex Doppler.
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Affiliation(s)
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care, Department of MedicineDavid Geffen School of Medicine at UCLALos AngelesCalifornia
| | - Andrew M. Eibl
- Health Sciences North Research InstituteSudburyOntarioCanada
| | | | - Bradley F. Long
- Health Sciences North Research InstituteSudburyOntarioCanada
- Northern Ontario School of MedicineSudburyOntarioCanada
| | - Joseph K. Eibl
- Health Sciences North Research InstituteSudburyOntarioCanada
- Northern Ontario School of MedicineSudburyOntarioCanada
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Fazelinejad Z, Hanafi MG, Amiripebdani F, Mosavi A. Comparison of cardiac output measured by carotid artery Doppler ultrasound and echocardiography in patients admitted to Golestan and Imam Khomeyni Hospitalsl in Ahvaz. J Family Med Prim Care 2020; 9:3304-3307. [PMID: 33102287 PMCID: PMC7567251 DOI: 10.4103/jfmpc.jfmpc_32_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/12/2020] [Accepted: 04/21/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction: Ultrasound is highly effective, safe, and cost-effective for monitoring the hemodynamics and measuring the cardiac output of patients. This study aims to investigate the value of cardiac output by the measurement of common carotid artery flow, which is an inexpensive, simple, and accessible method. Method: Doppler ultrasound of the carotid artery at thyroid level was obtained from the patients admitted to Golestan and Imam Khomeyni Hospitals in Ahvaz (the result is recorded medially from the bilateral outputs unless otherwise prescribed on one side due to a problem such as a catheter or specific position). A transthoracic echocardiography was also recorded using a portable device to measure the left ventricular outlet of diameter 0.5 cm below the aortic valve in the left parasternal with a long axis view. Results: Of the 94 patients studied between the ages of 25 to 87 years, 53 (56.4%) were males and 41 (43.6%) females with a mean age of 53.61 with a standard deviation of 14.56. There was a direct and significant relationship between age and cardiac output using both echocardiography and color Doppler carotid ultrasound (P < 0.001). Discussion: The results of this study showed that the measurement of cardiac output using color Doppler ultrasound in the case of inaccessible emergency echocardiography is a cheap, simple, and accessible method for the hemodynamic evaluation of patients.
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Affiliation(s)
- Zahra Fazelinejad
- Department of Radiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Ghasem Hanafi
- Department of Radiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Forough Amiripebdani
- Department of Radiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Aslan Mosavi
- Department of Cardiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Patel AK, Mistry K, Breslin K, Shokoohi H, Thomas-Mohtat R. Carotid Artery Flow Time Measured by Point-of-Care Ultrasound Correlates with Volume Changes in Pediatric Hemodialysis Patients. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1670-1676. [PMID: 32387153 DOI: 10.1016/j.ultrasmedbio.2020.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 06/11/2023]
Abstract
Carotid artery flow time corrected for heart rate (CFTc) correlates with intravascular volume changes in adults but has not been studied adequately in the pediatric population. We studied how fluid status changes correlate with CFTc in pediatric patients undergoing hemodialysis. This prospective observational study involved pediatric patients aged 5-18 y undergoing chronic hemodialysis at a tertiary care children's hospital in the United States. We measured CFTc by point-of-care ultrasound before and after each hemodialysis session, including passive leg raise. One hundred sixty-eight CFTc measurements were obtained from a total of 21 patient encounters. Post-dialysis CFTc decreased by 21.7 ms (95% confidence interval: 12.3-31.0) (p < 0.001). Pre- and post-dialysis ∆CFTc measurements were proportionally correlated with volume removed in dialysis adjusted for weight (mL/kg) (R2 = 0.224, p = 0.03). There was no significant change in mean CFTc with passive leg raise before or after hemodialysis. In children on hemodialysis, changes in CFTc were moderately correlated with decrease in intravascular volume after hemodialysis.
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Affiliation(s)
- Amit K Patel
- Division of Pediatric Emergency Medicine and Trauma Services, Children's National Health System, George Washington University, School of Medicine and Health Sciences, Washington, DC, USA
| | - Kirtida Mistry
- Division of Pediatric Nephrology, Children's National Health System, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Kristen Breslin
- Division of Pediatric Emergency Medicine and Trauma Services, Children's National Health System, George Washington University, School of Medicine and Health Sciences, Washington, DC, USA
| | - Hamid Shokoohi
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rosemary Thomas-Mohtat
- Division of Pediatric Emergency Medicine and Trauma Services, Children's National Health System, George Washington University, School of Medicine and Health Sciences, Washington, DC, USA.
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Cardiac output measurements via echocardiography versus thermodilution: A systematic review and meta-analysis. PLoS One 2019; 14:e0222105. [PMID: 31581196 PMCID: PMC6776392 DOI: 10.1371/journal.pone.0222105] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 08/21/2019] [Indexed: 12/03/2022] Open
Abstract
Echocardiography, as a noninvasive hemodynamic evaluation technique, is frequently used in critically ill patients. Different opinions exist regarding whether it can be interchanged with traditional invasive means, such as the pulmonary artery catheter thermodilution (TD) technique. This systematic review aimed to analyze the consistency and interchangeability of cardiac output measurements by ultrasound (US) and TD. Five electronic databases were searched for studies including clinical trials conducted up to June 2019 in which patients’ cardiac output was measured by ultrasound techniques (echocardiography) and TD. The methodological quality of the included studies was evaluated by two independent reviewers who used the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2), which was tailored according to our systematic review in Review Manager 5.3. A total of 68 studies with 1996 patients were identified as eligible. Meta-analysis and subgroup analysis were used to compare the cardiac output (CO) measured using the different types of echocardiography and different sites of Doppler use with TD. No significant differences were found between US and TD (random effects model: mean difference [MD], -0.14; 95% confidence interval, -0.30 to 0.02; P = 0.08). No significant differences were observed in the subgroup analyses using different types of echocardiography and different sites except for ascending aorta (AA) (random effects model: mean difference [MD], -0.37; 95% confidence interval, -0.74 to -0.01; P = 0.05) of Doppler use. The median of bias and limits of agreement were -0.12 and ±0.94 L/min, respectively; the median of correlation coefficient was 0.827 (range, 0.140–0.998). Although the difference in CO between echocardiography by different types or sites and TD was not entirely consistent, the overall effect of meta-analysis showed that no significant differences were observed between US and TD. The techniques may be interchangeable under certain conditions.
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Observational study in healthy volunteers to define interobserver reliability of ultrasound haemodynamic monitoring techniques performed by trainee doctors. Eur J Emerg Med 2019; 26:217-223. [DOI: 10.1097/mej.0000000000000533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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McGregor D, Sharma S, Gupta S, Ahmad S, Godec T, Harris T. Emergency department non-invasive cardiac output study (EDNICO): a feasibility and repeatability study. Scand J Trauma Resusc Emerg Med 2019; 27:30. [PMID: 30867006 PMCID: PMC6417111 DOI: 10.1186/s13049-019-0586-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/04/2019] [Indexed: 12/27/2022] Open
Abstract
Background There is little published data investigating non-invasive cardiac output monitoring in the emergency department (ED). We assessed six non-invasive fluid responsiveness monitoring methods which measure cardiac output directly or indirectly for their feasibility and repeatability of measurements in the ED: (1) left ventricular outflow tract echocardiography derived velocity time integral, (2) common carotid artery blood flow, (3) suprasternal aortic Doppler, (4) bioreactance, (5) plethysmography with digital vascular unloading method, and (6) inferior vena cava collapsibility index. Methods This is a prospective observational study of non-invasive methods of assessing fluid responsiveness in the ED. Participants were non-ventilated ED adult patients requiring intravenous fluid resuscitation. Feasibility of each method was determined by the proportion of clinically interpretable measurements from the number of measurement attempts. Repeatability was determined by comparing the mean difference of two paired measurements in a fluid steady state (after participants received an intravenous fluid bolus). Results 76 patients were recruited in the study. A total of 207 fluid responsiveness measurement sets were analysed. Feasibility rates were 97.6% for bioreactance, 91.3% for vascular unloading method with plethysmography, 87.4% for common carotid artery blood flow, 84.1% for inferior vena cava collapsibility index, 78.7% for LVOT VTI, and 76.8% for suprasternal aortic Doppler. The feasibility rates difference between bioreactance and all other methods was statistically significant. Conclusion Our study shows that non-invasive fluid responsiveness monitoring in the emergency department may be feasible with selected methods. Higher repeatability of measurements were observed in non-ultrasound methods. These findings have implications for further studies specifically assessing the accuracy of such non-invasive cardiac output methods and their effect on patient outcome in the ED in fluid depleted states such as sepsis. Electronic supplementary material The online version of this article (10.1186/s13049-019-0586-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- D McGregor
- Queen Mary University London and Barts Health NHS Trust, London, UK.
| | - S Sharma
- University of Western Australia School of Medicine and Pharmacology, Perth, Australia
| | - S Gupta
- University of Western Australia School of Medicine and Pharmacology, Perth, Australia
| | - S Ahmad
- Emergency Department Research Group, Royal London Hospital, London, UK
| | - T Godec
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Tim Harris
- Emergency Medicine, Queen Mary University London and Barts Health NHS Trust, London, UK
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Hill EC, Housh TJ, Smith CM, Keller JL, Schmidt RJ, Johnson GO. The Contributions of Arterial Cross-Sectional Area and Time-Averaged Flow Velocity to Arterial Blood Flow. J Med Ultrasound 2019; 26:186-193. [PMID: 30662149 PMCID: PMC6314092 DOI: 10.4103/jmu.jmu_20_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/02/2018] [Indexed: 11/09/2022] Open
Abstract
Background: Ultrasound has been used for noninvasive assessments of endothelial function in both clinical and athletic settings and to identify changes in muscle blood flow in response to exercise, nutritional supplementation, and occlusion. The purposes of the present study were to examine the reliability and relative contributions of arterial cross-sectional area and time-averaged flow velocity to predict muscle blood flow as a result of fatiguing exercise in men and women. Methods: Eighteen healthy men and 18 healthy women performed 50 consecutive eccentric repetitions of the elbow flexors at 60% of their pretest eccentric peak torque at a velocity of 180° s−1. Test-retest reliability and stepwise linear regression analyses were performed to determine the ability of arterial cross-sectional area and time-averaged flow velocity to predict brachial artery muscle blood flow for the men, women, and combined sample. Results: There was no systematic test versus retest mean differences (P > 0.05) for any of the ultrasound determined variables. The two-variable regression models significantly improved the ability to predict muscle blood flow and were associated with smaller standard error of the estimates (3.7%–10.1% vs. 16.8%–37.0% of the mean baseline muscle blood flow values) compared to the one-variable models. Conclusions: The findings of the present study supported the use of ultrasound for reliable assessments of arterial diameter, arterial cross-sectional area, time-averaged flow velocity, and muscle blood flow from the brachial artery in men and women. Furthermore, time-averaged flow velocity was a more powerful predictor of muscle blood flow than arterial cross-sectional area.
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Affiliation(s)
- Ethan C Hill
- Department of Nutrition and Health Sciences, Human Performance Laboratory, University of Nebraska-Lincoln, Lincoln, NE 68505, USA
| | - Terry J Housh
- Department of Nutrition and Health Sciences, Human Performance Laboratory, University of Nebraska-Lincoln, Lincoln, NE 68505, USA
| | - Cory M Smith
- Department of Nutrition and Health Sciences, Human Performance Laboratory, University of Nebraska-Lincoln, Lincoln, NE 68505, USA
| | - Joshua L Keller
- Department of Nutrition and Health Sciences, Human Performance Laboratory, University of Nebraska-Lincoln, Lincoln, NE 68505, USA
| | - Richard J Schmidt
- Department of Nutrition and Health Sciences, Human Performance Laboratory, University of Nebraska-Lincoln, Lincoln, NE 68505, USA
| | - Glen O Johnson
- Department of Nutrition and Health Sciences, Human Performance Laboratory, University of Nebraska-Lincoln, Lincoln, NE 68505, USA
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Saqr KM, Mansour O, Tupin S, Hassan T, Ohta M. Evidence for non-Newtonian behavior of intracranial blood flow from Doppler ultrasonography measurements. Med Biol Eng Comput 2018; 57:1029-1036. [PMID: 30523533 DOI: 10.1007/s11517-018-1926-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/30/2018] [Indexed: 11/30/2022]
Abstract
Computational fluid dynamics (CFD) studies of intracranial hemodynamics often use Newtonian viscosity model to close the shear rate term in the Navier-Stokes equation. This is based on a commonly accepted hypothesis which state that non-Newtonian effects can be neglected in intracranial blood flow. This study aims to examine the validity of such hypothesis to guide future CFD studies of intracranial hemodynamics. Doppler ultrasonography (DUS) measurements of systolic and diastolic vessel diameter and blood velocity were conducted on 16 subjects (mean age 50.6). The measurements were conducted on the internal carotid (ICA), middle cerebral (MCA), and anterior communicating (AComA) arteries. Systolic and diastolic wall shear stress (WSS) values were calculated via the Hagen-Poiseuille exact solution using Newtonian and three different non-Newtonian models: namely Carreau, power-law and Herschel-Bulkley models. The Weissenberg-Rabinowitsch correction for blood shear-thinning viscosity was applied to the non-Newtonian models. The error percentage between the two sets of models was calculated and discussed. The Newtonian hypothesis was tested statistically and discussed using paired t tests. Significant differences (P < 0.0001) were found between the Newtonian and non-Newtonian WSS in ICA. In MCA and AComA, similar differences were found except in the systole and diastole for the Herschel-Bulkley and power-law models (P = 0.0669, P = 0.7298), respectively. The error between the Newtonian and non-Newtonian models ranged from - 27 to 30% (0.2 to 2.2 Pa). These values could affect the physical interpretation of IA CFD studies. Evidence suggests that the Newtonian assumption may be inappropriate to investigate intracranial hemodynamics. Graphical abstract The WSS estimation error resulting from using the Newtonian assumption compared to three non-Newtonian models for ICA, MCA, and AComA in systole and diastole conditions, based on TCCD measurements of 16 subjects. The error due to the Newtonian assumption ranged from 0.2 to 2.2 Pa (- 27 to 30%). These values could affect the physical interpretation of IA CFD studies.
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Affiliation(s)
- Khalid M Saqr
- Biomedical Flow Dynamics Laboratory, Institute of Fluid Science, Tohoku University, Sendai, Miyagi, 980-8577, Japan. .,College of Engineering and Technology, Arab Academy for Science, Technology and Maritime Transport (AASTMT), Abu Kir, Alexandria, 1029, Egypt. .,Research Center for Computational Neurovascular Biomechanics (RCCNB), Smouha University Hospital, Alexandria University, Alexandria, 21648, Egypt.
| | - Ossama Mansour
- Research Center for Computational Neurovascular Biomechanics (RCCNB), Smouha University Hospital, Alexandria University, Alexandria, 21648, Egypt.,Department of Neurology, Stroke Unit, Alexandria University School of Medicine, Azarita Medical Campus, Alexandria, 21514, Egypt
| | - Simon Tupin
- Biomedical Flow Dynamics Laboratory, Institute of Fluid Science, Tohoku University, Sendai, Miyagi, 980-8577, Japan
| | - Tamer Hassan
- Research Center for Computational Neurovascular Biomechanics (RCCNB), Smouha University Hospital, Alexandria University, Alexandria, 21648, Egypt.,Department of Neurosurgery, Alexandria University School of Medicine, Azarita Medical Campus, Alexandria, 21514, Egypt
| | - Makoto Ohta
- Biomedical Flow Dynamics Laboratory, Institute of Fluid Science, Tohoku University, Sendai, Miyagi, 980-8577, Japan
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Sex differences for fatigue-induced changes in muscle blood flow, but not eccentric peak torque or neuromuscular responses. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2018; 18:427-437. [PMID: 30511947 PMCID: PMC6313047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the effects of exercise intensity and strength on sex-related differences in eccentric peak torque (PT), muscle blood flow, and neuromuscular responses following fatiguing, submaximal forearm flexion eccentric protocols. METHODS Thirty-six subjects were stratified by sex and strength into 4 equal groups and randomly performed fatiguing eccentric, isokinetic (180°·s-1), forearm flexion protocols at 40% or 80% of eccentric PT. Eccentric PT, muscle blood flow, and neuromuscular responses were measured prior to (pretest), immediately (posttest), and 5-min after (5-min recovery) performing the fatiguing protocols. RESULTS There was no sex-, intensity-, or strength-related difference in the magnitude of decrease in eccentric PT at posttest (80.0% of pretest) or the magnitude of recovery at 5-min (87.8% of pretest). Muscle blood flow increased similarly for men (139.8% of pretest) and women (178.7% of pretest) at posttest, but the magnitude of recovery was greater for the women (62.9%) than the men (41.4%). The neuromuscular responses were not affected by sex-, intensity-, or strength-related differences. CONCLUSIONS These findings indicated that there were few sex-related differences in eccentric PT, muscle blood flow, and neuromuscular responses as a result of the fatiguing eccentric protocols performed at a high or low intensity of exercise.
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Girotto V, Teboul JL, Beurton A, Galarza L, Guedj T, Richard C, Monnet X. Carotid and femoral Doppler do not allow the assessment of passive leg raising effects. Ann Intensive Care 2018; 8:67. [PMID: 29845417 PMCID: PMC5975047 DOI: 10.1186/s13613-018-0413-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 05/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The hemodynamic effects of the passive leg raising (PLR) test must be assessed through a direct measurement of cardiac index (CI). We tested whether changes in Doppler common carotid blood flow (CBF) and common femoral artery blood flow (FBF) could detect a positive PLR test (increase in CI ≥ 10%). We also tested whether CBF and FBF changes could track simultaneous changes in CI during PLR and volume expansion. In 51 cases, we measured CI (PiCCO2), CBF and FBF before and during a PLR test (one performed for CBF and another for FBF measurements) and before and after volume expansion, which was performed if PLR was positive. RESULTS Due to poor echogenicity or insufficient Doppler signal quality, CBF could be measured in 39 cases and FBF in only 14 cases. A positive PLR response could not be detected by changes in CBF, FBF, carotid nor by femoral peak systolic velocities (areas under the receiver operating characteristic curves: 0.58 ± 0.10, 0.57 ± 0.16, 0.56 ± 0.09 and 0.64 ± 10, respectively, all not different from 0.50). The correlations between simultaneous changes in CI and CBF and in CI and FBF during PLR and volume expansion were not significant (p = 0.41 and p = 0.27, respectively). CONCLUSION Doppler measurements of CBF and of FBF, as well as measurements of their peak velocities, are not reliable to assess cardiac output and its changes.
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Affiliation(s)
- Valentina Girotto
- Service de Réanimation Médicale, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Sud, Insert UMR_999, Université Paris-Sud, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France.
| | - Jean-Louis Teboul
- Service de Réanimation Médicale, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Sud, Insert UMR_999, Université Paris-Sud, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Alexandra Beurton
- Service de Réanimation Médicale, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Sud, Insert UMR_999, Université Paris-Sud, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Laura Galarza
- Service de Réanimation Médicale, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Sud, Insert UMR_999, Université Paris-Sud, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Thierry Guedj
- Service de Radiologie, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Sud, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Christian Richard
- Service de Réanimation Médicale, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Sud, Insert UMR_999, Université Paris-Sud, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Xavier Monnet
- Service de Réanimation Médicale, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Sud, Insert UMR_999, Université Paris-Sud, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France
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Peng QY, Zhang LN, Ai ML, Li L, Hu CH, Zhang YX, Liu W, Feng Q, Zou Y, Ai YH. Common Carotid Artery Sonography Versus Transthoracic Echocardiography for Cardiac Output Measurements in Intensive Care Unit Patients. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1793-1799. [PMID: 28429475 DOI: 10.1002/jum.14214] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 11/05/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES This study was designed to test the effectiveness of common carotid artery sonography in comparison with transthoracic echocardiography (TTE) for cardiac output measurements to provide an easier alternative for cardiac output monitoring in the intensive care unit. METHODS This study included 148 patients who had common carotid artery Doppler examinations and TTE performed within 8 hours of each other, and the cardiac output measurement results were compared with each other. RESULTS The mean age of the participants ± SD was 56.8 ± 16.2 years, with male patients composing 54.7% of the cohort. There was no significant difference in carotid and TTE cardiac output between different sexes, age groups, patients with and without mechanical ventilation, and primary indication groups. The overall intraclass correlation coefficient between the carotid and TTE cardiac output was 0.537. In patients with septic shock, multiple trauma, and respiratory failure, the intraclass correlation coefficients between TTE and carotid cardiac output were 0.241, 0.061, and 0.095, respectively. CONCLUSIONS Carotid cardiac output shows moderate agreement with TTE cardiac output; thus, its use may be considered as an alternative for estimating cardiac output in emergencies and when TTE cardiac output is unobtainable. However, in patients with septic shock, multiple trauma, and respiratory failure, the use of carotid cardiac output is not recommended.
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Affiliation(s)
- Qian-Yi Peng
- Department of Critical Care Medicine, Central South University, Changsha, China
| | - Li-Na Zhang
- Department of Critical Care Medicine, Central South University, Changsha, China
| | - Mei-Lin Ai
- Department of Critical Care Medicine, Central South University, Changsha, China
| | - Li Li
- Department of Critical Care Medicine, Central South University, Changsha, China
| | - Cheng-Huan Hu
- Department of Critical Care Medicine, Central South University, Changsha, China
| | - Yan-Xin Zhang
- Department of Critical Care Medicine, Central South University, Changsha, China
| | - Wei Liu
- Department of Critical Care Medicine, Central South University, Changsha, China
| | - Qing Feng
- Department of Critical Care Medicine, Central South University, Changsha, China
| | - Yu Zou
- Department of Anesthesia Xiang-ya Hospital, Central South University, Changsha, China
| | - Yu-Hang Ai
- Department of Critical Care Medicine, Central South University, Changsha, China
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Ukor IF, Hilton AK, Bailey MJ, Bellomo R. The haemodynamic effects of bolus versus slower infusion of intravenous crystalloid in healthy volunteers. J Crit Care 2017; 41:254-259. [PMID: 28599199 DOI: 10.1016/j.jcrc.2017.05.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/19/2017] [Accepted: 05/30/2017] [Indexed: 01/12/2023]
Abstract
PURPOSE This pilot study aimed to characterise the haemodynamic effect of 1L of IV normal saline (NS) administered as a rapid versus slow infusion on cardiac output (CO), heart rate (HR), systemic blood pressures, and carotid blood flow in six healthy volunteers. MATERIALS AND METHODS Six healthy male volunteers aged 18-65years were randomized to receive 1L NS given over 30min or 120min. On a subsequent study session the alternate fluid regimen was administered. Haemodynamic data was gathered using a non-invasive finger arterial pressure monitor (Nexfin®), echocardiography and carotid duplex sonography. Time to micturition and urine volume was also assessed. RESULTS Compared to baseline, rapid infusion of 1L of saline over 30min produced a fall in Nexfin®-measured CO by 0.62L/min (p<0.001), whereas there was a marginal but significant increase during infusion of 1L NS over 120min of 0.02L/min (p<0.001). This effect was mirrored by changes in HR and blood pressure (BP) (p<0.001). There were no significant changes in carotid blood flow, time to micturition, or urine volume produced. CONCLUSIONS Slower infusion of 1L NS in healthy male volunteers produced a greater increase in CO, HR and BP than rapid infusion.
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Affiliation(s)
- Ida F Ukor
- Department of Intensive Care, Austin Hospital, Heidelberg 3081, Melbourne, VIC, Australia; Department of Anaesthesia and Perioperative Medicine, Monash Medical Centre, Clayton 3168, Melbourne, VIC, Australia.
| | - Andrew K Hilton
- Department of Intensive Care, Austin Hospital, Heidelberg 3081, Melbourne, VIC, Australia
| | - Michael J Bailey
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Alfred Centre, Prahran 3181, Melbourne, VIC, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Heidelberg 3081, Melbourne, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Alfred Centre, Prahran 3181, Melbourne, VIC, Australia
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Roehrig C, Govier M, Robinson J, Aneman A. Carotid Doppler flowmetry correlates poorly with thermodilution cardiac output following cardiac surgery. Acta Anaesthesiol Scand 2017; 61:31-38. [PMID: 27766613 DOI: 10.1111/aas.12822] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 08/23/2016] [Accepted: 08/29/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND It remains unclear whether measuring carotid arterial flow by the time velocity integral using vascular Doppler ultrasound can be used to monitor cardiac output and volume responsiveness. METHODS The carotid Doppler flow (time velocity integral and peak flow velocity variation) was assessed in triplicate by an intensivist with formal vascular ultrasound training. Thirty-three patients admitted following coronary by-pass surgery were studied before and after a passive leg-raising manoeuvre to investigate volume responsiveness (more than 10% increase in cardiac output) along with indices of arterial load measuring cardiac output by thermodilution. Pearson's correlation coefficient and area under the curve (AUC) by receiver operating characteristics were calculated. RESULTS A significant correlation between carotid Doppler flow and cardiac output was demonstrated in post-operative cardiac surgery patients (r = 0.80 [95%CI 0.61-0.89]), including relative changes following passive leg raising (r = 0.79 [95%CI 0.60-0.89]) that showed a mean difference of 2% with wide limits of agreements (-19% to 16%). Changes in carotid Doppler flow following passive leg raising correlated with the baseline arterial resistance but not with compliance or effective elastance. A peak flow variation > 10% before passive leg raising discriminated responders to the manoeuvre with an AUC of 0.81 [95% CI 0.55-0.95]. CONCLUSIONS Weak correlations between common carotid Doppler flow and cardiac output mean that the methods cannot be used interchangeably in post-operative cardiac surgery patients.
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Affiliation(s)
- C. Roehrig
- Intensive Care Unit; Liverpool Hospital; Sydney South West Local Health District; Liverpool NSW Australia
| | - M. Govier
- Intensive Care Unit; Liverpool Hospital; Sydney South West Local Health District; Liverpool NSW Australia
| | - J. Robinson
- Department of Vascular Surgery; Liverpool Hospital; Sydney South West Local Health District; Liverpool NSW Australia
| | - A. Aneman
- Intensive Care Unit; Liverpool Hospital; Sydney South West Local Health District; Liverpool NSW Australia
- University of New South Wales; South Western Sydney Clinical School; Liverpool NSW Australia
- The Ingham Institute for Applied Medical Research; Liverpool NSW Australia
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Peachey T, Tang A, Baker EC, Pott J, Freund Y, Harris T. The assessment of circulating volume using inferior vena cava collapse index and carotid Doppler velocity time integral in healthy volunteers: a pilot study. Scand J Trauma Resusc Emerg Med 2016; 24:108. [PMID: 27590048 PMCID: PMC5010685 DOI: 10.1186/s13049-016-0298-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/22/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Assessment of circulating volume and the requirement for fluid replacement are fundamental to resuscitation but remain largely empirical. Passive leg raise (PLR) may determine fluid responders while avoiding potential fluid overload. We hypothesised that inferior vena cava collapse index (IVCCI) and carotid artery blood flow would change predictably in response to PLR, potentially providing a non-invasive tool to assess circulating volume and identifying fluid responsive patients. METHODS We conducted a prospective proof of concept pilot study on fasted healthy volunteers. One operator measured IVC diameter during quiet respiration and sniff, and carotid artery flow. Stroke volume (SV) was also measured using suprasternal Doppler. Our primary endpoint was change in IVCCI after PLR. We also studied changes in IVCCI after "sniff", and correlation between carotid artery flow and SV. RESULTS Passive leg raise was associated with significant reduction in the mean inferior vena cava collapsibility index from 0.24 to 0.17 (p < 0.01). Mean stroke volume increased from 56.0 to 69.2 mL (p < 0.01). There was no significant change in common carotid artery blood flow. Changes in physiology consequent upon passive leg raise normalised rapidly. DISCUSSION Passive leg raise is associated with a decrease of IVCCI and increase in stroke volume. However, the wide range of values observed suggests that factors other than circulating volume predominate in determining the proportion of collapse with respiration. CONCLUSION In contrast to other studies, we did not find that carotid blood flow increased with passive leg raise. Rapid normalisation of post-PLR physiology may account for this.
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Affiliation(s)
- Tom Peachey
- Emergency Department, Royal London Hospital, Barts Health NHS Trust, Whitechapel Rd, London, E1 1BB UK
| | - Andrew Tang
- Emergency Department, Royal London Hospital, Barts Health NHS Trust, Whitechapel Rd, London, E1 1BB UK
| | - Elinor C. Baker
- Emergency Department, Royal London Hospital, Barts Health NHS Trust, Whitechapel Rd, London, E1 1BB UK
| | - Jason Pott
- Emergency Department, Royal London Hospital, Barts Health NHS Trust, Whitechapel Rd, London, E1 1BB UK
| | - Yonathan Freund
- Emergency Department, Royal London Hospital, Barts Health NHS Trust, Whitechapel Rd, London, E1 1BB UK
- Sorbonne université, UPMC univ Paris-06, Paris, France
| | - Tim Harris
- Emergency Department, Royal London Hospital, Barts Health NHS Trust, Whitechapel Rd, London, E1 1BB UK
- Emergency Department, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
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Volumetric blood flow measurement using Doppler ultrasound: concerns about the technique. J Ultrasound 2015; 18:201-4. [PMID: 26191112 DOI: 10.1007/s40477-015-0164-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 02/28/2015] [Indexed: 10/23/2022] Open
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