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Kenny JÉS, Eibl JK, Horner C, Arcozzi D, Bonomi F, Fanelli V, Visioli A, Goffi A, Piva S. Hemodynamic Insights From Simultaneous Common Carotid and Internal Jugular Doppler Ultrasonography in a Patient With Hypoxemia and Multiple Organ Dysfunction. Chest 2024; 165:e107-e112. [PMID: 38599754 DOI: 10.1016/j.chest.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/12/2023] [Accepted: 11/08/2023] [Indexed: 04/12/2024] Open
Affiliation(s)
- Jon-Émile S Kenny
- Health Sciences North Research Institute, Sudbury, ON, Canada; Flosonics Medical, Sudbury, ON, Canada.
| | - Joseph K Eibl
- Health Sciences North Research Institute, Sudbury, ON, Canada; Flosonics Medical, Sudbury, ON, Canada; Northern Ontario School of Medicine, Sudbury, ON, Canada
| | | | - Daniele Arcozzi
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Federico Bonomi
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Vito Fanelli
- Department of Anesthesia, Critical Care and Emergency, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Antonio Visioli
- Department of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Alberto Goffi
- Department of Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; St. Michael's Hospital and Li Ka Shing Knowledge Institute, Keenan Research Centre, Unity Health Toronto, Toronto, ON, Canada
| | - Simone Piva
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
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Kerrebijn I, Atwi S, Elfarnawany M, Eibl AM, Eibl JK, Taylor JL, Kim CH, Johnson BD, Kenny JÉS. The correlation between carotid artery Doppler and stroke volume during central blood volume loss and resuscitation. Acute Crit Care 2024; 39:162-168. [PMID: 38476069 PMCID: PMC11002613 DOI: 10.4266/acc.2023.01095] [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: 08/23/2023] [Revised: 12/14/2023] [Accepted: 01/23/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Using peripheral arteries to infer central hemodynamics is common among hemodynamic monitors. Doppler ultrasound of the common carotid artery has been used in this manner with conflicting results. We investigated the relationship between changing common carotid artery Doppler measures and stroke volume (SV), hypothesizing that more consecutively-averaged cardiac cycles would improve SV-carotid Doppler correlation. METHODS Twenty-seven healthy volunteers were recruited and studied in a physiology laboratory. Carotid artery Doppler pulse was measured with a wearable, wireless ultrasound during central hypovolemia and resuscitation induced by a stepped lower body negative pressure protocol. The change in maximum velocity time integral (VTI) and corrected flow time of the carotid artery (ccFT) were compared with changing SV using repeated measures correlation. RESULTS In total, 73,431 cardiac cycles were compared across 27 subjects. There was a strong linear correlation between changing SV and carotid Doppler measures during simulated hemorrhage (repeated-measures linear correlation [Rrm ]=0.91 for VTI; 0.88 for ccFT). This relationship improved with larger numbers of consecutively-averaged cardiac cycles. For ccFT, beyond four consecutively-averaged cardiac cycles the correlation coefficient remained strong (i.e., Rrm of at least 0.80). For VTI, the correlation coefficient with SV was strong for any number of averaged cardiac cycles. For both ccFT and VTI, Rrm remained stable around 25 consecutively-averaged cardiac cycles. CONCLUSIONS There was a strong linear correlation between changing SV and carotid Doppler measures during central blood volume loss. The strength of this relationship was dependent upon the number of consecutively-averaged cardiac cycles.
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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 University, Sudbury, ON, Canada
| | - Jenna L. Taylor
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
- Physiology and Ultrasound Laboratory in Science and Exercise, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, 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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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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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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Kerrebijn I, Munding CE, Horner C, Atwi S, Elfarnawany M, Eibl AM, Eibl JK, Taylor JL, Kim CH, Johnson BD, Kenny JÉS. The Correlation between Carotid Artery Corrected Flow Time and Velocity Time Integral during Central Blood Volume Loss and Resuscitation. J Med Ultrasound 2023; 31:309-313. [PMID: 38264586 PMCID: PMC10802870 DOI: 10.4103/jmu.jmu_80_23] [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: 07/09/2023] [Revised: 08/18/2023] [Accepted: 09/01/2023] [Indexed: 01/25/2024] Open
Abstract
Background Doppler ultrasound of the common carotid artery is used to infer central hemodynamics. For example, change in the common carotid artery corrected flow time (ccFT) and velocity time integral (VTI) are proposed surrogates of changing stroke volume. However, conflicting data exist which may be due to inadequate beat sample size and measurement variability - both intrinsic to handheld systems. In this brief communication, we determined the correlation between changing ccFT and carotid VTI during progressively severe central blood volume loss and resuscitation. Methods Measurements were obtained through a novel, wireless, wearable Doppler ultrasound system. Sixteen participants (ages of 18-40 years with no previous medical history) were studied across 25 lower body-negative pressure protocols. Relationships were assessed using repeated-measures correlation regression models. Results In total, 33,110 cardiac cycles comprise this analysis; repeated-measures correlation showed a strong, linear relationship between ccFT and VTI. The strength of the ccFT-VTI relationship was dependent on the number of consecutively averaged cardiac cycles (R1 cycle = 0.70, R2 cycles = 0.74, and R10 cycles = 0.81). Conclusions These results positively support future clinical investigations employing common carotid artery Doppler as a surrogate for central hemodynamics.
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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
- Department of Cardiovascular Diseases, Human Integrative and Environmental Physiology Laboratory, Mayo Clinic, Rochester, MN, USA
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Chul Ho Kim
- Department of Cardiovascular Diseases, Human Integrative and Environmental Physiology Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Bruce D. Johnson
- Department of Cardiovascular Diseases, Human Integrative and Environmental Physiology Laboratory, 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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Kenny JÉS, Gibbs SO, Eibl JK, Eibl AM, Yang Z, Johnston D, Munding CE, Elfarnawany M, Lau VC, Kemp BO, Nalla B, Atoui R. Simultaneous venous-arterial Doppler during preload augmentation: illustrating the Doppler Starling curve. Ultrasound J 2023; 15:32. [PMID: 37505318 PMCID: PMC10382420 DOI: 10.1186/s13089-023-00330-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023] Open
Abstract
Providing intravenous (IV) fluids to a patient with signs or symptoms of hypoperfusion is common. However, evaluating the IV fluid 'dose-response' curve of the heart is elusive. Two patients were studied in the emergency department with a wireless, wearable Doppler ultrasound system. Change in the common carotid arterial and internal jugular Doppler spectrograms were simultaneously obtained as surrogates of left ventricular stroke volume (SV) and central venous pressure (CVP), respectively. Both patients initially had low CVP jugular venous Doppler spectrograms. With preload augmentation, only one patient had arterial Doppler measures indicative of significant SV augmentation (i.e., 'fluid responsive'). The other patient manifested diminishing arterial response, suggesting depressed SV (i.e., 'fluid unresponsive') with evidence of ventricular asynchrony. In this short communication, we describe how a wireless, wearable Doppler ultrasound simultaneously tracks surrogates of cardiac preload and output within a 'Doppler Starling curve' framework; implications for IV fluid dosing are discussed.
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Affiliation(s)
- Jon-Émile S Kenny
- Health Sciences North Research Institute, Sudbury, ON, Canada.
- Flosonics Medical, 325 W. Front Street, Toronto, ON, Canada.
| | | | - Joseph K Eibl
- Health Sciences North Research Institute, Sudbury, ON, Canada
- Flosonics Medical, 325 W. Front Street, Toronto, ON, Canada
- NOSM University, Sudbury, ON, Canada
| | - Andrew M Eibl
- Health Sciences North Research Institute, Sudbury, ON, Canada
- Flosonics Medical, 325 W. Front Street, Toronto, ON, Canada
| | - Zhen Yang
- Flosonics Medical, 325 W. Front Street, Toronto, ON, Canada
| | | | | | | | - Vivian C Lau
- OSF Saint Francis Medical Center, Peoria, IL, USA
| | | | - Bhanu Nalla
- Health Sciences North Research Institute, Sudbury, ON, Canada
- NOSM University, Sudbury, ON, Canada
| | - Rony Atoui
- Health Sciences North Research Institute, Sudbury, ON, Canada
- NOSM University, Sudbury, ON, Canada
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Munding CE, Kenny JÉS, Yang Z, Clarke G, Elfarnawany M, Eibl AM, Eibl JK, Nalla B, Atoui R. Detecting the Change in Total Circulatory Flow with a Wireless, Wearable Doppler Ultrasound Patch: A Pilot Study. Crit Care Explor 2023; 5:e0914. [PMID: 37168690 PMCID: PMC10166367 DOI: 10.1097/cce.0000000000000914] [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] [Indexed: 05/13/2023] Open
Abstract
Measuring fluid responsiveness is important in the management of critically ill patients, with a 10-15% change in cardiac output typically being used to indicate "fluid responsiveness." Ideally, these changes would be measured noninvasively and peripherally. The aim of this study was to determine how the common carotid artery (CCA) maximum velocity changes with total circulatory flow when confounding factors are mitigated and determine a value for CCA maximum velocity corresponding to a 10% change in total circulatory flow. DESIGN Prospective observational pilot study. SETTING Patients undergoing elective, on-pump coronary artery bypass grafting (CABG) surgery. PATIENTS Fourteen patients were referred for elective coronary artery bypass grafting surgery. INTERVENTIONS Cardiopulmonary bypass (CPB) pump flow changes during surgery, as chosen by the perfusionist. MEASUREMENTS A hands-free, wearable Doppler patch was used for CCA velocity measurements with the aim of preventing user errors in ultrasound measurements. Maximum CCA velocity was determined from the spectrogram acquired by the Doppler patch. CPB flow rates were recorded as displayed on the CPB console, and further measured from the peristaltic pulsation frequency visible on the recorded Doppler spectrograms. MAIN RESULTS Changes in CCA maximum velocity tracked well with changes in CPB flow. On average, a 13.6% change in CCA maximum velocity was found to correspond to a 10% change in CPB flow rate. CONCLUSIONS Changes in CCA velocity may be a useful surrogate for determining fluid responsiveness when user error can be mitigated.
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Affiliation(s)
| | - Jon-Émile S Kenny
- Flosonics Medical, Sudbury, ON, Canada
- Health Sciences North Research Institute, Sudbury ON, Canada
| | - Zhen Yang
- Flosonics Medical, Sudbury, ON, Canada
| | - Geoffrey Clarke
- Flosonics Medical, Sudbury, ON, Canada
- Health Sciences North Research Institute, Sudbury ON, Canada
| | | | - Andrew M Eibl
- Flosonics Medical, Sudbury, ON, Canada
- Health Sciences North Research Institute, Sudbury ON, Canada
| | - Joseph K Eibl
- Flosonics Medical, Sudbury, ON, Canada
- Health Sciences North Research Institute, Sudbury ON, Canada
- Northern Ontario School of Medicine, Sudbury ON, Canada
| | - Bhanu Nalla
- Health Sciences North Research Institute, Sudbury ON, Canada
- Northern Ontario School of Medicine, Sudbury ON, Canada
| | - Rony Atoui
- Health Sciences North Research Institute, Sudbury ON, Canada
- Northern Ontario School of Medicine, Sudbury ON, Canada
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Prager R, Pratte M, Kenny JE, Rola P. A Wireless, Wearable Carotid Doppler Ultrasound Aids Diagnosis and Monitoring of Pericardial Tamponade: A Case Report. Crit Care Explor 2023; 5:e0911. [PMID: 37181538 PMCID: PMC10168526 DOI: 10.1097/cce.0000000000000911] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Pericardial tamponade can often be diagnosed through clinical findings and echocardiography; however, the diagnosis can be aided by demonstrating the hemodynamic consequences of the effusion. We describe the use of a wearable carotid Doppler device to help diagnose and monitor pericardial tamponade. CASE SUMMARY A 54-year-old man developed hypotension after an endobronchial biopsy for a lung mass. Echocardiography showed a pericardial effusion with sonographic evidence of tamponade. A wearable carotid Doppler device demonstrated low corrected carotid flow time (CFT) (a surrogate for stroke volume) with significant respiratory variation, supporting the diagnosis of tamponade. The patient underwent pericardiocentesis which revealed purulent pericardial fluid from a mediastinal abscess. After drainage there was increased CFT and reduced respiratory variability in Doppler, surrogates of improved stroke volume. CONCLUSION A wearable carotid Doppler device is a noninvasive tool that can help determine the hemodynamic impact of a pericardial effusion, and potentially aid in the diagnosis of pericardial tamponade.
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Affiliation(s)
- Ross Prager
- Division of Critical Care, Western University, London, ON, Canada
| | - Michael Pratte
- Department of Medicine, University of Ottawa. Ottawa, ON, Canada
| | - Jon-Emile Kenny
- Health Sciences North Research Institute, Sudbury, ON, Canada
- Flosonics Medical, Toronto, ON, Canada
| | - Philippe Rola
- Internal Medicine and Intensive Care, Santa Cabrini Ospedale, Montreal, QC, Canada
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Kenny JES, Yang Z, Clarke G, Elfarnawany M, Munding CE, Eibl AM, Eibl JK, Taylor JL, Kim CH, Johnson BD. A Novel Spectral Index for Tracking Preload Change from a Wireless, Wearable Doppler Ultrasound. Diagnostics (Basel) 2023; 13:diagnostics13091590. [PMID: 37174981 PMCID: PMC10178522 DOI: 10.3390/diagnostics13091590] [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: 03/15/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
A wireless, wearable Doppler ultrasound offers a new paradigm for linking physiology to resuscitation medicine. To this end, the image analysis of simultaneously-acquired venous and arterial Doppler spectrograms attained by wearable ultrasound represents a new source of hemodynamic data. Previous investigators have reported a direct relationship between the central venous pressure (CVP) and the ratio of the internal jugular-to-common carotid artery diameters. Because Doppler power is directly related to the number of red cell scatterers within a vessel, we hypothesized that (1) the ratio of internal jugular-to-carotid artery Doppler power (V/APOWER) would be a surrogate for the ratio of the vascular areas of these two vessels and (2) the V/APOWER would track the anticipated CVP change during simulated hemorrhage and resuscitation. To illustrate this proof-of-principle, we compared the change in V/APOWER obtained via a wireless, wearable Doppler ultrasound to B-mode ultrasound images during a head-down tilt. Additionally, we elucidated the change in the V/APOWER during simulated hemorrhage and transfusion via lower body negative pressure (LBNP) and release. With these Interesting Images, we show that the Doppler V/APOWER ratio qualitatively tracks anticipated changes in CVP (e.g., cardiac preload) which is promising for both diagnosis and management of hemodynamic unrest.
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Affiliation(s)
- Jon-Emile S Kenny
- Health Sciences North Research Institute, Sudbury, ON P3E 2H3, Canada
- Flosonics Medical, Toronto, ON P3C 1R7, Canada
| | - Zhen Yang
- Flosonics Medical, Toronto, ON P3C 1R7, Canada
| | - Geoffrey Clarke
- Health Sciences North Research Institute, Sudbury, ON P3E 2H3, Canada
- Flosonics Medical, Toronto, ON P3C 1R7, Canada
| | | | | | - Andrew M Eibl
- Health Sciences North Research Institute, Sudbury, ON P3E 2H3, Canada
- Flosonics Medical, Toronto, ON P3C 1R7, Canada
| | - Joseph K Eibl
- Health Sciences North Research Institute, Sudbury, ON P3E 2H3, Canada
- Flosonics Medical, Toronto, ON P3C 1R7, Canada
- Northern Ontario School of Medicine, Sudbury, ON P3E 2C6, Canada
| | - Jenna L Taylor
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
| | - Chul-Ho Kim
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
| | - Bruce D Johnson
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
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Kenny JES, Prager R, Rola P, McCulloch G, Eibl JK, Haycock K. The effect of gravity-induced preload change on the venous excess ultrasound (VExUS) score and internal jugular vein Doppler in healthy volunteers. Intensive Care Med Exp 2023; 11:19. [PMID: 37055637 PMCID: PMC10102271 DOI: 10.1186/s40635-023-00504-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/20/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND The venous excess ultrasound (VExUS) score is a multi-organ Doppler approach to assess venous congestion. Despite growing use of VExUS in research and clinical practice, other veins can be visualized to assess for venous hypertension, which may overcome acquisition barriers of the VExUS exam. In this pilot, observational study, we used a wearable Doppler ultrasound to assess the relationship between jugular venous Doppler and the VExUS score under different preload conditions. We hypothesized that jugular Doppler morphology would accurately distinguish preload conditions, that it would most closely relate to the hepatic venous Doppler morphology in the fully supine position and that the VExUS score would be influenced by preload condition. RESULTS We recruited 15 healthy volunteers with no cardiovascular history. Preload change was achieved using a tilt-table with three positions: supine, fully upright, and 30-degree head-down tilt. In each position, a VExUS score was performed; furthermore, inferior vena collapsibility and sphericity index were calculated. At the same time, jugular venous Doppler was captured by a novel, wireless, wearable ultrasound system. A continuous jugular venous Doppler morphology was 96% accurate for detecting the low preload condition. The jugular venous Doppler morphology was highly correlated with the hepatic vein, but only in the supine position. Gravitational position did not significantly affect the sphericity index or the VExUS score. CONCLUSIONS The jugular vein Doppler morphology was able to accurately distinguish low from high preload conditions in healthy volunteers. Comparisons between VExUS Doppler morphologies and other veins should occur in the supine position when gravitational pressure gradients are minimized; finally, different preload conditions in healthy subjects did not affect the VExUS score.
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Affiliation(s)
- Jon-Emile S Kenny
- Health Sciences North Research Institute, 56 Walford Rd, Sudbury, ON, P3E 2H2, Canada.
- Flosonics Medical, Toronto, ON, Canada.
| | - Ross Prager
- Division of Critical Care Medicine, Western University, London, ON, Canada
| | - Philippe Rola
- Intensive Care Unit, Santa Cabrini Hospital, Montreal, QC, Canada
| | | | - Joseph K Eibl
- Health Sciences North Research Institute, 56 Walford Rd, Sudbury, ON, P3E 2H2, Canada
- Flosonics Medical, Toronto, ON, Canada
- Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Korbin Haycock
- Department of Emergency Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA
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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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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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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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Kenny JÉS, Munding CE, Eibl AM, Eibl JK. Wearable ultrasound and provocative hemodynamics: a view of the future. Crit Care 2022; 26:329. [PMID: 36284332 PMCID: PMC9597974 DOI: 10.1186/s13054-022-04206-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/28/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jon-Émile S. Kenny
- grid.420638.b0000 0000 9741 4533Health Sciences North Research Institute, 56 Walford Rd, Sudbury, ON P3E 2H2 Canada ,Flosonics Medical, Sudbury, ON Canada
| | | | - Andrew M. Eibl
- grid.420638.b0000 0000 9741 4533Health Sciences North Research Institute, 56 Walford Rd, Sudbury, ON P3E 2H2 Canada ,Flosonics Medical, Sudbury, ON Canada
| | - Joseph K. Eibl
- grid.420638.b0000 0000 9741 4533Health Sciences North Research Institute, 56 Walford Rd, Sudbury, ON P3E 2H2 Canada ,Flosonics Medical, Sudbury, ON Canada ,grid.436533.40000 0000 8658 0974Northern Ontario School of Medicine, Sudbury, ON Canada
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15
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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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Kenny JÉS, Barjaktarevic I, Eibl AM, Parrotta M, Long BF, Elfarnawany M, Eibl JK. Temporal concordance between pulse contour analysis, bioreactance and carotid doppler during rapid preload changes. PLoS One 2022; 17:e0265711. [PMID: 35320307 PMCID: PMC8942202 DOI: 10.1371/journal.pone.0265711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/07/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose
We describe the temporal concordance of 3 hemodynamic monitors.
Materials and methods
Healthy volunteers performed preload changes while simultaneously wearing a non-invasive, pulse-contour stroke volume (SV) monitor, a bioreactance SV monitor and a wireless, wearable Doppler ultrasound patch over the common carotid artery. The sensitivity and specificity for detecting preload change over 3 temporal windows (early, middle and late) was assessed.
Results
40 preload changes were recorded in total (20 increase, 20 decrease). Immediately, the wearable Doppler had high sensitivity (100%) and specificity (100%) for detecting preload change with an area under the receiver operator curve (AUROC) of 0.98 for both velocity time integral (VTI, 10.5% threshold) and corrected flow time (FTc, 2.5% threshold). The sensitivity, specificity and AUROC for non-invasive pulse contour were equally good (9% SV threshold). For bioreactance, a 13% SV threshold immediately detected preload change with a sensitivity, specificity and AUROC of 60%, 95% and 0.75, respectively. After two SV outputs following preload change, the sensitivity, specificity and AUROC of bioreactance improved to 70%, 90% and 0.85, respectively.
Conclusions
Carotid Doppler ultrasound and non-invasive pulse contour detected rapid hemodynamic change with equal accuracy; bioreactance improved over time. Algorithm-lag should be considered when interpreting clinical studies.
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Affiliation(s)
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Andrew M. Eibl
- Health Sciences North Research Institute, Sudbury, ON, Canada
| | | | - Bradley F. Long
- Health Sciences North Research Institute, Sudbury, ON, Canada
- Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Mai Elfarnawany
- Health Sciences North Research Institute, Sudbury, ON, Canada
| | - Joseph K. Eibl
- Health Sciences North Research Institute, Sudbury, ON, Canada
- Northern Ontario School of Medicine, Sudbury, ON, Canada
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Kenny JES. Is the Carotid Artery a Window to the Left Ventricle? Indian J Crit Care Med 2022; 26:406. [PMID: 35519920 PMCID: PMC9015929 DOI: 10.5005/jp-journals-10071-24140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Kenny JES. Is the Carotid Artery a Window to the Left Ventricle? Indian J Crit Care Med 2022;26(3):406.
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Affiliation(s)
- Jon-Emile S Kenny
- Jon-Emile S Kenny, Department of Medicine, Health Sciences North Research Institute, Sudbury, Ontario, Canada, e-mail:
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18
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Kundu R, Maitra S, Chowhan G, Baidya DK. In Response to: Is the Carotid Artery a Window to the Left Ventricle? Indian J Crit Care Med 2022; 26:407. [PMID: 35519908 PMCID: PMC9015915 DOI: 10.5005/jp-journals-10071-24141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We think correlation of Doppler ultrasound derived CA-VTI and echocardiography derived SV needs further exploration in a larger sample and in various models of hypovolemia and shock under ideal measurement conditions before concluding whether carotid artery can be considered a true window to the left ventricle.
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Affiliation(s)
- Riddhi Kundu
- Department of Critical Care Medicine, Manipal Hospital, Dwarka, New Delhi, India
| | - Souvik Maitra
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Ganesh Chowhan
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Dalim Kumar Baidya
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
- Dalim Kumar Baidya, Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India, Phone: +91 1126593212, e-mail:
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Assessing Fluid Intolerance with Doppler Ultrasonography: A Physiological Framework. Med Sci (Basel) 2022; 10:medsci10010012. [PMID: 35225945 PMCID: PMC8883898 DOI: 10.3390/medsci10010012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 12/11/2022] Open
Abstract
Ultrasonography is becoming the favored hemodynamic monitoring utensil of emergentologists, anesthesiologists and intensivists. While the roles of ultrasound grow and evolve, many clinical applications of ultrasound stem from qualitative, image-based protocols, especially for diagnosing and managing circulatory failure. Often, these algorithms imply or suggest treatment. For example, intravenous fluids are opted for or against based upon ultrasonographic signs of preload and estimation of the left ventricular ejection fraction. Though appealing, image-based algorithms skirt some foundational tenets of cardiac physiology; namely, (1) the relationship between cardiac filling and stroke volume varies considerably in the critically ill, (2) the correlation between cardiac filling and total vascular volume is poor and (3) the ejection fraction is not purely an appraisal of cardiac function but rather a measure of coupling between the ventricle and the arterial load. Therefore, management decisions could be enhanced by quantitative approaches, enabled by Doppler ultrasonography. Both fluid ‘responsiveness’ and ‘tolerance’ are evaluated by Doppler ultrasound, but the physiological relationship between these constructs is nebulous. Accordingly, it is argued that the link between them is founded upon the Frank–Starling–Sarnoff relationship and that this framework helps direct future ultrasound protocols, explains seemingly discordant findings and steers new routes of enquiry.
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Kenny JÉS, Eibl JK, Mackenzie DC, Barjaktarevic I. Guidance of IV Fluid by Ultrasound Will Improve With Technology. Chest 2022; 161:e132-e133. [DOI: 10.1016/j.chest.2021.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 11/26/2022] Open
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21
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Carotid artery velocity time integral and corrected flow time measured by a wearable Doppler ultrasound detect stroke volume rise from simulated hemorrhage to transfusion. BMC Res Notes 2022; 15:7. [PMID: 35012624 PMCID: PMC8750810 DOI: 10.1186/s13104-021-05896-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/21/2021] [Indexed: 12/13/2022] Open
Abstract
Objective Doppler ultrasonography of the common carotid artery is used to infer stroke volume change and a wearable Doppler ultrasound has been designed to improve this workflow. Previously, in a human model of hemorrhage and resuscitation comprising approximately 50,000 cardiac cycles, we found a strong, linear correlation between changing stroke volume, and measures from the carotid Doppler signal, however, optimal Doppler thresholds for detecting a 10% stroke volume change were not reported. In this Research Note, we present these thresholds, their sensitivities, specificities and areas under their receiver operator curves (AUROC). Results Augmentation of carotid artery maximum velocity time integral and corrected flowtime by 18% and 4%, respectively, accurately captured 10% stroke volume rise. The sensitivity and specificity for these thresholds were identical at 89% and 100%. These data are similar to previous investigations in healthy volunteers monitored by the wearable ultrasound.
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22
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Kenny JÉS, Clarke G, Myers M, Elfarnawany M, Eibl AM, Eibl JK, Nalla B, Atoui R. A Wireless Wearable Doppler Ultrasound Detects Changing Stroke Volume: Proof-of-Principle Comparison with Trans-Esophageal Echocardiography during Coronary Bypass Surgery. Bioengineering (Basel) 2021; 8:203. [PMID: 34940356 PMCID: PMC8698882 DOI: 10.3390/bioengineering8120203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND A novel, wireless, ultrasound biosensor that adheres to the neck and measures real-time Doppler of the carotid artery may be a useful functional hemodynamic monitor. A unique experimental set-up during elective coronary artery bypass surgery is described as a means to compare the wearable Doppler to trans-esophageal echocardiography (TEE). METHODS A total of two representative patients were studied at baseline and during Trendelenburg position. Carotid Doppler spectra from the wearable ultrasound and TEE were synchronously captured. Areas under the receiver operator curve (AUROC) were performed to assess the accuracy of changing common carotid artery velocity time integral (ccVTI∆) at detecting a clinically significant change in stroke volume (SV∆). RESULTS Synchronously measuring and comparing Doppler spectra from the wearable ultrasound and TEE is feasible during Trendelenburg positioning. In two representative cardiac surgical patients, the ccVTI∆ accurately detected a clinically significant SV∆ with AUROCs of 0.89, 0.91, and 0.95 when single-beat, 3-consecutive beat and 10-consecutive beat averages were assessed, respectively. CONCLUSION In this proof-of-principle research communication, a wearable Doppler ultrasound system is successfully compared to TEE. Preliminary data suggests that the diagnostic accuracy of carotid Doppler ultrasonography at detecting clinically significant SV∆ is enhanced by averaging more cardiac cycles.
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Affiliation(s)
- Jon-Émile Stuart Kenny
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada; (G.C.); (A.M.E.); (J.K.E.); (B.N.); (R.A.)
- Flosonics Medical, 325 Front Street, Toronto, ON M5V 2Y1, Canada; (M.M.); (M.E.)
| | - Geoffrey Clarke
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada; (G.C.); (A.M.E.); (J.K.E.); (B.N.); (R.A.)
- Flosonics Medical, 325 Front Street, Toronto, ON M5V 2Y1, Canada; (M.M.); (M.E.)
| | - Matt Myers
- Flosonics Medical, 325 Front Street, Toronto, ON M5V 2Y1, Canada; (M.M.); (M.E.)
| | - Mai Elfarnawany
- Flosonics Medical, 325 Front Street, Toronto, ON M5V 2Y1, Canada; (M.M.); (M.E.)
| | - Andrew M. Eibl
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada; (G.C.); (A.M.E.); (J.K.E.); (B.N.); (R.A.)
- Flosonics Medical, 325 Front Street, Toronto, ON M5V 2Y1, Canada; (M.M.); (M.E.)
| | - Joseph K. Eibl
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada; (G.C.); (A.M.E.); (J.K.E.); (B.N.); (R.A.)
- Flosonics Medical, 325 Front Street, Toronto, ON M5V 2Y1, Canada; (M.M.); (M.E.)
- Northern Ontario School of Medicine, Sudbury, ON P3E 2C6, Canada
| | - Bhanu Nalla
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada; (G.C.); (A.M.E.); (J.K.E.); (B.N.); (R.A.)
- Northern Ontario School of Medicine, Sudbury, ON P3E 2C6, Canada
| | - Rony Atoui
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada; (G.C.); (A.M.E.); (J.K.E.); (B.N.); (R.A.)
- Northern Ontario School of Medicine, Sudbury, ON P3E 2C6, Canada
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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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Kenny JS, Elfarnawany M, Yang Z, Myers M, Eibl AM, Eibl JK, Taylor JL, Kim CH, Johnson BD. The Doppler shock index measured by a wearable ultrasound patch accurately detects moderate-to-severe central hypovolemia during lower body negative pressure. J Am Coll Emerg Physicians Open 2021; 2:e12533. [PMID: 34401869 PMCID: PMC8349221 DOI: 10.1002/emp2.12533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/22/2021] [Accepted: 07/20/2021] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Moderate-to-severe hemorrhage is a life-threatening condition, which is challenging to detect in a timely fashion using traditional vital signs because of the human body's robust physiologic compensatory mechanisms. Measuring and trending blood flow could improve diagnosis of clinically significant exsanguination. A lightweight, wireless, wearable Doppler ultrasound patch that captures and trends blood flow velocity could enhance hemorrhage detection. METHODS In 11 healthy volunteers undergoing simulated hemorrhage and resuscitation during graded lower body negative pressure (LBNP) and release, we studied the relationship between stroke volume (SV) and common carotid artery velocity time integral (VTI) and corrected flow time (FTc). We assessed the diagnostic accuracy of 2 variations of a novel metric, the Doppler shock index (ie, the DSIVTI and DSIFTc), at capturing moderate-to-severe central hypovolemia defined as a 30% reduction in SV. The DSIVTI and DSIFTc are calculated as the heart rate divided by either the VTI or FTc, respectively. RESULTS A total of 17,822 cardiac cycles were analyzed across 22 LBNP protocols. The average SV reduction to the lowest tolerated LBNP stage was 40%; there was no clinically significant fall in the mean arterial pressure. Correlations between changing SV and the common carotid artery VTI and FTc were strong (R 2 of 0.87, respectively) and concordant. The DSIVTI and DSIFTc accurately detected moderate-to-severe central hypovolemia with values for the area under the receiver operator curves of 0.96 and 0.97, respectively. CONCLUSION In a human model of hemorrhage and resuscitation, measures from a wearable Doppler ultrasound patch correlated strongly with SV and identified moderate-to-severe central hypovolemia with excellent diagnostic accuracy.
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Affiliation(s)
| | - Mai Elfarnawany
- Health Sciences North Research InstituteSudburyOntarioCanada
- Flosonics MedicalSudburyOntarioCanada
| | - Zhen Yang
- Health Sciences North Research InstituteSudburyOntarioCanada
- Flosonics MedicalSudburyOntarioCanada
| | - Matt Myers
- Health Sciences North Research InstituteSudburyOntarioCanada
- Flosonics MedicalSudburyOntarioCanada
| | - Andrew M. Eibl
- Health Sciences North Research InstituteSudburyOntarioCanada
| | - Joseph K. Eibl
- Health Sciences North Research InstituteSudburyOntarioCanada
- Northern Ontario School of MedicineSudburyOntarioCanada
| | - Jenna L. Taylor
- Human Integrative and Environmental Physiology LaboratoryDepartment of Cardiovascular DiseasesMayo ClinicRochesterMinnesotaUSA
| | - Chul Ho Kim
- Human Integrative and Environmental Physiology LaboratoryDepartment of Cardiovascular DiseasesMayo ClinicRochesterMinnesotaUSA
| | - Bruce D. Johnson
- Human Integrative and Environmental Physiology LaboratoryDepartment of Cardiovascular DiseasesMayo ClinicRochesterMinnesotaUSA
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