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Cheong I, Otero Castro V, Sosa FA, Tort Oribe B, Früchtenicht MF, Tamagnone FM, Merlo PM. Passive leg raising test using the carotid flow velocity-time integral to predict fluid responsiveness. J Ultrasound 2024; 27:97-104. [PMID: 37668901 PMCID: PMC10909041 DOI: 10.1007/s40477-023-00824-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/08/2023] [Indexed: 09/06/2023] Open
Abstract
PURPOSE The passive leg raising test (PLR) is a noninvasive method widely adopted to assess fluid responsiveness. We propose to explore if changes in the carotid flow assessed by echo-Doppler can predict fluid responsiveness after a PLR. METHODS We conducted a performance diagnostic study in two intensive care units from Argentina between February and April 2022. We included patients with signs of tissular hypoperfusion that required fluid resuscitation. We labeled the patients as fluid responders when we measured, after a fluid bolus, an increase greater than 15% in the left ventricle outflow tract (LVOT) VTI in an apical 5-chamber view and we compared those results with the carotid flow (CF) velocity-time integral (VTI) from the left supraclavicular region in a semi-recumbent position and during the PLR. RESULTS Of the 62 eligible patients, 50 patients (80.6%) were included. The area under the ROC curve for a change in CF VTI during the PLR test was 0.869 (95% CI 0.743-0.947). An increase of at least of 11% in the CF VTI with the PLR predicted fluid-responsiveness with a sensitivity of 77.3% (95% CI 54.6-92.2%) and specificity of 78.6% (95% CI 59-91.7%). The positive predictive value was 73.9% (95% CI 57.4-85.6%) and the negative predictive value was 81.5% (95% CI 66.5-90.7%). The positive likelihood ratio was 3.61 and the negative likelihood ratio was 0.29. CONCLUSION An increase greater than 11% in CF VTI after a PLR may be useful to predict fluid responsiveness among critically ill patients.
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Affiliation(s)
- Issac Cheong
- Department of Critical Care Medicine, Sanatorio de Los Arcos, Juan B. Justo 909, CABA, Buenos Aires, Argentina.
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina.
| | - Victoria Otero Castro
- Department of Critical Care Medicine, Sanatorio de Los Arcos, Juan B. Justo 909, CABA, Buenos Aires, Argentina
| | - Fernando Ariel Sosa
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina
- Department of Critical Care Medicine, Hospital Alemán, Buenos Aires, Argentina
| | - Bárbara Tort Oribe
- Department of Critical Care Medicine, Hospital Alemán, Buenos Aires, Argentina
| | | | | | - Pablo Martín Merlo
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina
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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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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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van Houte J, Raaijmaakers AE, Mooi FJ, Meijs LPB, de Boer EC, Suriani I, Houterman S, Montenij LJ, Bouwman AR. Evaluating corrected carotid flow time as a non-invasive parameter for trending cardiac output and stroke volume in cardiac surgery patients. J Ultrasound 2023; 26:89-97. [PMID: 35397758 PMCID: PMC10063698 DOI: 10.1007/s40477-022-00678-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/16/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE The corrected carotid flow time (ccFT) is derived from a pulsed-wave Doppler signal at the common carotid artery. Several equations are currently used to calculate ccFT. Its ability to assess the intravascular volume status non-invasively has recently been investigated. The purpose of this study was to evaluate the correlation and trending ability of ccFT with invasive cardiac output (CO) and stroke volume (SV) measurements. METHODS Eighteen cardiac surgery patients were included in this prospective observational study. ccFT measurements were obtained at three time points: after induction of anesthesia (T1), after a passive leg raise (T2), and post-bypass (T3). Simultaneously, CO and SV were measured by calibrated pulse contour analysis. Three different equations (Bazett, Chambers, and Wodey) were used to calculate ccFT. The correlation and percentage change in time (concordance) between ccFT and CO and between ccFT and SV were evaluated. RESULTS Mean ccFT values differed significantly for the three equations (p < 0.001). The correlation between ccFT and CO and between ccFT and SV was highest for Bazett's (ρ = 0.43, p < 0.0001) and Wodey's (ρ = 0.33, p < 0.0001) equations, respectively. Concordance between ΔccFT and ΔCO and between ΔccFT and ΔSV was highest for Bazett's (100%) and Wodey's (82%) equations, respectively. Subgroup analysis demonstrated that correlation and concordance between SV and ccFT improved when assessed within limited heart rate (HR) ranges. CONCLUSION The use of different ccFT equations leads to variable correlation and concordance rates between ccFT and CO/SV measurements. Bazett's equation acceptably tracked CO changes in time, while the trending capability of SV was poor.
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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.
- Department of Anesthesiology and Intensive Care, Catharina Hospital, P.O. Box 1350, 5602 ZA, Eindhoven, The Netherlands.
| | - Anniek E Raaijmaakers
- Deparment of Anesthesiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frederik J Mooi
- Deparment of Anesthesiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Loek P B Meijs
- Department of Intensive Care, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Esmée C de Boer
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Irene Suriani
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Saskia Houterman
- Department of Education and Research, 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
| | - Arthur R Bouwman
- Department of Anesthesiology, Catharina Hospital, Eindhoven, 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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High-rate settlement and unconsciousness with shime-waza in young judo athletes from a video analytic study in Judo World Championships. J Sci Med Sport 2022; 25:942-947. [PMID: 36167661 DOI: 10.1016/j.jsams.2022.09.001] [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: 02/20/2022] [Revised: 08/14/2022] [Accepted: 09/02/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES We aimed to investigate the incidence rate of unconsciousness related to shime-waza and the accompanying symptoms by age categories using video analysis of the Judo World Championships. DESIGN Observational retrospective study. METHODS We included 6918 elite judo athletes and 7426 bouts from the Judo World Championships between 2015 and 2021. Incidence rates of matches settled using shime-waza and unconsciousness were calculated by age categories: cadet, junior, and senior. Furthermore, in cases of unconsciousness resulting from shime-waza, the duration of choking initiation and release, unconsciousness, and awareness were recorded from video analysis and compared by the presence of post-awareness symptoms. A relationship between the duration of shime-waza and the post-awareness symptoms was investigated using receiver operating characteristic analysis. RESULTS Shime-waza was used to settle 307 (4.1 %) bouts comprising 6.0 %, 4.4 %, and 3.0 % of the cadet, junior, and senior bouts, respectively (p < 0.001). The unconsciousness rates were 18.9 %, 14.6 %, and 4.3 % in the cadet, junior (p = 0.008), and senior bouts (p < 0.001), respectively. Among the 39 unconsciousness cases, 24 (61.5 %) showed convulsions or staggers after awareness. The duration from unconsciousness to choking release in cases with and without symptoms was 5.0 ± 3.5 s and 2.4 ± 2.0 s, respectively (p = 0.009); moreover, this duration was significantly correlated with the duration from unconsciousness to awareness (ρ = 0.480, p = 0.002). The cut-off point for symptom occurrence was a duration from unconsciousness to choking release of ≥4 s (area under the curve = 0.746, p = 0.003, odds ratio = 6.7). CONCLUSIONS Considering the risk of unconsciousness and accompanying symptoms resulting from shime-waza, appropriate education and responses are required.
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Monnet X, Shi R, Teboul JL. Prediction of fluid responsiveness. What’s new? Ann Intensive Care 2022; 12:46. [PMID: 35633423 PMCID: PMC9148319 DOI: 10.1186/s13613-022-01022-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/09/2022] [Indexed: 02/07/2023] Open
Abstract
AbstractAlthough the administration of fluid is the first treatment considered in almost all cases of circulatory failure, this therapeutic option poses two essential problems: the increase in cardiac output induced by a bolus of fluid is inconstant, and the deleterious effects of fluid overload are now clearly demonstrated. This is why many tests and indices have been developed to detect preload dependence and predict fluid responsiveness. In this review, we take stock of the data published in the field over the past three years. Regarding the passive leg raising test, we detail the different stroke volume surrogates that have recently been described to measure its effects using minimally invasive and easily accessible methods. We review the limits of the test, especially in patients with intra-abdominal hypertension. Regarding the end-expiratory occlusion test, we also present recent investigations that have sought to measure its effects without an invasive measurement of cardiac output. Although the limits of interpretation of the respiratory variation of pulse pressure and of the diameter of the vena cava during mechanical ventilation are now well known, several recent studies have shown how changes in pulse pressure variation itself during other tests reflect simultaneous changes in cardiac output, allowing these tests to be carried out without its direct measurement. This is particularly the case during the tidal volume challenge, a relatively recent test whose reliability is increasingly well established. The mini-fluid challenge has the advantage of being easy to perform, but it requires direct measurement of cardiac output, like the classic fluid challenge. Initially described with echocardiography, recent studies have investigated other means of judging its effects. We highlight the problem of their precision, which is necessary to evidence small changes in cardiac output. Finally, we point out other tests that have appeared more recently, such as the Trendelenburg manoeuvre, a potentially interesting alternative for patients in the prone position.
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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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Horejsek J, Kunstyr J, Michalek P, Porizka M. Novel Methods for Predicting Fluid Responsiveness in Critically Ill Patients—A Narrative Review. Diagnostics (Basel) 2022; 12:diagnostics12020513. [PMID: 35204603 PMCID: PMC8871108 DOI: 10.3390/diagnostics12020513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/04/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
In patients with acute circulatory failure, fluid administration represents a first-line therapeutic intervention for improving cardiac output. However, only approximately 50% of patients respond to fluid infusion with a significant increase in cardiac output, defined as fluid responsiveness. Additionally, excessive volume expansion and associated hyperhydration have been shown to increase morbidity and mortality in critically ill patients. Thus, except for cases of obvious hypovolaemia, fluid responsiveness should be routinely tested prior to fluid administration. Static markers of cardiac preload, such as central venous pressure or pulmonary artery wedge pressure, have been shown to be poor predictors of fluid responsiveness despite their widespread use to guide fluid therapy. Dynamic tests including parameters of aortic blood flow or respiratory variability of inferior vena cava diameter provide much higher diagnostic accuracy. Nevertheless, they are also burdened with several significant limitations, reducing the reliability, or even precluding their use in many clinical scenarios. This non-systematic narrative review aims to provide an update on the novel, less employed dynamic tests of fluid responsiveness evaluation in critically ill patients.
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Affiliation(s)
- Jan Horejsek
- Department of Anaesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 12808 Prague, Czech Republic; (J.H.); (J.K.); (P.M.)
| | - Jan Kunstyr
- Department of Anaesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 12808 Prague, Czech Republic; (J.H.); (J.K.); (P.M.)
| | - Pavel Michalek
- Department of Anaesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 12808 Prague, Czech Republic; (J.H.); (J.K.); (P.M.)
- Department of Anaesthesia, Antrim Area Hospital, Antrim BT41 2RL, UK
| | - Michal Porizka
- Department of Anaesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 12808 Prague, Czech Republic; (J.H.); (J.K.); (P.M.)
- Correspondence: ; Tel.: +420-702-089-475
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Pace R, Lassola S, Miori S, Cammarota G, Barbariol F, Vetrugno L. Carotid vs aortic velocity time integral and peak velocity to predict fluid responsiveness in mechanically ventilated patients. A comparative study. Minerva Anestesiol 2021; 88:352-360. [PMID: 34761663 DOI: 10.23736/s0375-9393.21.16035-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The carotid artery velocity-time integral (CVTI) and the carotid Doppler peak velocity (cDPV), as well as measures of their variation induced by the respiratory cycle, have been proposed as fast and easy to obtain ultrasound measures for assessing fluid responsiveness in intensive care unit patients. To investigate this possibility, we conducted a prospective observational study in hemodynamically unstable patients under mechanical ventilation. METHODS From May 1 to December 31, 2019, we conducted a prospective observational study involving 50 hemodynamically unstable patients under mechanical ventilation. We obtained a total of 800 Doppler ultrasound measurements from the left common carotid artery and at the level of the aortic annulus in the apical five-chamber view. The two measurements were performed before and after a 7 mL/kg fluid challenge and within the first hour of the onset of hemodynamic instability. The maximum Doppler peak velocity, the minimum Doppler peak velocity, and the maximum and minimum VTI at both the aortic and carotid level were acquired. RESULTS Twenty-eight (56%) patients showed a ≥15% increase in AoVTI after the fluid challenge, and were therefore identified as "fluid responders". All Doppler measurements were always significantly greater (p <0.0001) in fluid responders in relation to both carotid and aortic parameters. Good agreement between the above-mentioned measurements was found: Cohen's kappa coefficient between the carotid and aortic ΔDPV was 0.76 (95% CI 0.58 - 0.94); and between the Carotid and Aortic ΔVTI it was 0.84 (95% CI 0.68 - 0.99). CONCLUSIONS CDPV was found to predict fluid responsiveness in unstable mechanically ventilated patients.
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Affiliation(s)
- Rocco Pace
- Intensive Care Unit, Department of Anesthesia and Intensive Care, Santa Chiara Hospital, APSS, Trento, Italy -
| | - Sergio Lassola
- Intensive Care Unit, Department of Anesthesia and Intensive Care, Santa Chiara Hospital, APSS, Trento, Italy
| | - Sara Miori
- Intensive Care Unit, Department of Anesthesia and Intensive Care, Santa Chiara Hospital, APSS, Trento, Italy
| | | | | | - Luigi Vetrugno
- University-Hospital of Udine, ASFC, Udine, Italy.,Department of Medicine, University of Udine, Udine, Italy
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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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12
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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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13
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Chowhan G, Kundu R, Maitra S, Arora MK, Batra RK, Subramaniam R, Baidya DK, Trikha A. Efficacy of Left Ventricular Outflow Tract and Carotid Artery Velocity Time Integral as Predictors of Fluid Responsiveness in Patients with Sepsis and Septic Shock. Indian J Crit Care Med 2021; 25:310-316. [PMID: 33790513 PMCID: PMC7991757 DOI: 10.5005/jp-journals-10071-23764] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Transthoracic echocardiography is a reliable method to measure a dynamic change in left ventricular outflow tract velocity time integral (LVOTVTI) and stroke volume (SV) in response to passive leg raising (PLR) and can predict fluid responsiveness in critically ill patients. Measuring carotid artery velocity time integral (CAVTI) is easier, does not depend on adequate cardiac window, and requires less skill and expertise than LVOTVTI. The aim of this study is to identify the efficacy of ΔCAVTI and ΔLVOTVTI pre- and post-PLR in predicting fluid responsiveness in critically ill patients with sepsis and septic shock. Methods: After the institutional ethics committee's clearance and informed written consent, 60 critically ill mechanically ventilated patients aged 18-65 years were recruited in this prospective parallel-group study with 20 patients in each group: sepsis (group S), septic shock (group SS), and control (group C). Demographic parameters and baseline acute physiology, age and chronic health evaluation-II and sequential organ failure assessment scores were noted. LVOTVTI, SV, and CAVTI were measured before and after PLR along with other hemodynamic variables. Patients having a change in SV more than 15% following PLR were defined as "responders." Results: Twenty-three patients (38.33%) were responders. Area under receiver-operating characteristic curve for ΔCAVTI could predict responders in control and sepsis patients only. The correlation coefficients between pre- and post-PLR ΔCAVTI and ΔLVOTVTI were 0.530 (p = 0.016), 0.440 (p = 0.052), and 0.044 (p = 0.853) in control, sepsis, and septic shock patients, respectively. Conclusion: Following PLR, ΔCAVTI does not predict fluid responsiveness in septic shock patients and the correlation between ΔCAVTI and ΔLVOTVTI is weak in septic shock patients and only modest in sepsis patients. How to cite this article: Chowhan G, Kundu R, Maitra S, Arora MK, Batra RK, Subramaniam R, et al. Efficacy of Left Ventricular Outflow Tract and Carotid Artery Velocity Time Integral as Predictors of Fluid Responsiveness in Patients with Sepsis and Septic Shock. Indian J Crit Care Med 2021;25(3):310-316. CTRI/Trial Reg No: www.ctri.nic.in, CTRI/2017/11/010434.
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Affiliation(s)
- Ganesh Chowhan
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Riddhi Kundu
- Department of Critical Care Medicine, Manipal Hospitals, Dwarka, New Delhi, India
| | - Souvik Maitra
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Mahesh K Arora
- Department of Liver Transplant, Anaesthesia and Critical Care, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ravinder K Batra
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeshwari Subramaniam
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Dalim K Baidya
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Beier L, Davis J, Esener D, Grant C, Fields JM. Carotid Ultrasound to Predict Fluid Responsiveness: A Systematic Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1965-1976. [PMID: 32314817 DOI: 10.1002/jum.15301] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 03/09/2020] [Accepted: 03/17/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To perform a systematic review of the accuracy of carotid ultrasound measures in determining volume responsiveness in adults. METHODS We conducted a systematic review of Ovid MEDLINE and Scopus from conception until January 1, 2019. Two independent reviewers used an iterative process to identify relevant articles and abstract information from them. The quality and risk of bias were assessed with the Quality Assessment of Diagnostic Accuracy Studies version 2 tool. RESULTS We identified 17 relevant articles with 956 patients. The 2 most frequently cited carotid measures of fluid responsiveness were corrected flow time and peak velocity or change in peak velocity with respiration (ΔCDPV). Accordingly, the diagnostic characteristics of corrected flow time in these studies varied widely, with sensitivities from 60% to 73%, specificities from 82% to 92%, and areas under the receiver operating characteristic curves from 0.75 to 0.88. Optimal cutoff values for ΔCDPV ranged from 9.1% to 14%, with areas under the receiver operating characteristic curves from 0.81 to 0.91, sensitivities from 73% to 86%, and specificities from 78% to 86%. Other measures, such as carotid blood flow and carotid diameter, had limited data to support their use. Heterogeneity of the studies prohibited a meta-analysis. Most studies had a moderate risk of bias and high applicability. CONCLUSIONS Preliminary research suggests that carotid ultrasound measures may be useful adjunct measures of fluid status; however, they should not be interpreted as absolute and should be placed in a clinical context. The most well-defined and supported measure currently is ΔCDPV, with cutoffs from 9% to 14%. Corrected flow time shows promise, because of heterogeneity of how this value is measured, an optimal cutoff has not been established.
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Affiliation(s)
- Lance Beier
- Department of Emergency Medicine, Kaiser Permanente San Diego, San Diego, California, USA
| | - Joshua Davis
- Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Dasia Esener
- Department of Emergency Medicine, Kaiser Permanente San Diego, San Diego, California, USA
| | - Charles Grant
- Department of Emergency Medicine, Kaiser Permanente San Diego, San Diego, California, USA
| | - J Matthew Fields
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Hamzaoui O, Gouëzel C, Jozwiak M, Millereux M, Sztrymf B, Prat D, Jacobs F, Monnet X, Trouiller P, Teboul JL. Increase in Central Venous Pressure During Passive Leg Raising Cannot Detect Preload Unresponsiveness. Crit Care Med 2020; 48:e684-e689. [PMID: 32697509 DOI: 10.1097/ccm.0000000000004414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE By analogy with the classical central venous pressure rules to assess a fluid challenge, we hypothesized that an increase in central venous pressure greater than or equal to 5 cm H2O (i.e., 4 mm Hg) during passive leg raising can predict preload unresponsiveness diagnosed by the absence of increase in velocity-time integral of the left ventricular outflow tract greater than or equal to 10% during the test (negative passive leg raising test). DESIGN AND SETTINGS Velocity-time integral was measured by transthoracic echocardiography. Central venous pressure and velocity-time integral were measured before and during passive leg raising. PATIENTS Critically ill patients for whom the physician decided to test preload responsiveness by passive leg raising were prospectively included. MEASUREMENT AND MAIN RESULTS Fifty-seven set of measurements were performed in 50 patients. Preload unresponsiveness (negative passive leg raising test) was observed in 32 cases. The changes in central venous pressure during passive leg raising did not differ between positive passive leg raising cases (positive passive leg raising test) and negative passive leg raising test cases (3 ± 2 vs 3 ± 2 mm Hg, respectively) and thus did not predict preload unresponsiveness (area under the receiver-operating characteristic curve of 0.59). An increase in central venous pressure greater than or equal to 4 mm Hg during passive leg raising was observed in 10 cases of positive passive leg raising test and in 11 cases of negative passive leg raising test. Taking an increase in central venous pressure greater than or equal to 3 or greater than or equal to 5 mm Hg rather than greater than or equal to 4 mm Hg during passive leg raising did not better allow one to identify negative passive leg raising test. CONCLUSIONS Marked increase in central venous pressure during passive leg raising cannot identify negative passive leg raising test cases and thus preload unresponsiveness. Measurements of cardiac output (or its surrogates) during passive leg raising are, thus, mandatory to appropriately interpret this test.
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Affiliation(s)
- Olfa Hamzaoui
- Service de Réanimation Polyvalente, Hôpital Antoine Béclère, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Corentin Gouëzel
- Service de Réanimation Polyvalente, Hôpital Antoine Béclère, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Mathieu Jozwiak
- Service de Médecine Intensive-Réanimation, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Maude Millereux
- Service de Réanimation Polyvalente, Hôpital Antoine Béclère, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Benjamin Sztrymf
- Service de Réanimation Polyvalente, Hôpital Antoine Béclère, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Dominique Prat
- Service de Réanimation Polyvalente, Hôpital Antoine Béclère, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Frederic Jacobs
- Service de Réanimation Polyvalente, Hôpital Antoine Béclère, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Xavier Monnet
- Service de Médecine Intensive-Réanimation, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Pierre Trouiller
- Service de Réanimation Polyvalente, Hôpital Antoine Béclère, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Jean-Louis Teboul
- Service de Médecine Intensive-Réanimation, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
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Monnet X, Teboul JL. Prediction of fluid responsiveness in spontaneously breathing patients. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:790. [PMID: 32647715 PMCID: PMC7333112 DOI: 10.21037/atm-2020-hdm-18] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/25/2020] [Indexed: 01/01/2023]
Abstract
In patients with acute circulatory failure, the primary goal of volume expansion is to increase cardiac output. However, this expected effect is inconstant, so that in many instances, fluid administration does not result in any haemodynamic benefit. In such cases, fluid could only exert some deleterious effects. It is now well demonstrated that excessive fluid administration is harmful, especially during acute respiratory distress syndrome and in sepsis or septic shock. This is the reason why some tests and indices have been developed in order to assess "fluid responsiveness" before deciding to perform volume expansion. While preload markers have been used for many years for this purpose, they have been repeatedly shown to be unreliable, which is mainly related to physiological issues. As alternatives, "dynamic" indices have been introduced. These indices are based upon the changes in cardiac output or stroke volume resulting from various changes in preload conditions, induced by heart-lung interactions, postural manoeuvres or by the infusion of small amounts of fluids. The haemodynamic effects and the reliability of these "dynamic" indices of fluid responsiveness are now well described. From their respective advantages and limitations, it is also possible to describe their clinical interest and the clinical setting in which they are applicable.
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Affiliation(s)
- Xavier Monnet
- Hôpitaux Universitaires Paris-Saclay, Assistance Publique - Hôpitaux de Paris, Hôpital de Bicêtre, Service de Médecine Intensive-Réanimation, Le Kremlin-Bicêtre, France
- Inserm UMR S_999, Univ Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Jean-Louis Teboul
- Hôpitaux Universitaires Paris-Saclay, Assistance Publique - Hôpitaux de Paris, Hôpital de Bicêtre, Service de Médecine Intensive-Réanimation, Le Kremlin-Bicêtre, France
- Inserm UMR S_999, Univ Paris-Saclay, Le Kremlin-Bicêtre, France
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Huang D, Ma H, Ma J, Hong L, Lian X, Wu Y, Wu Y, Wang S, Qin T, Tan N. A novel supplemental maneuver to predict fluid responsiveness in critically ill patients: blood pump-out test performed before renal replacement therapy. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:786. [PMID: 32647711 PMCID: PMC7333114 DOI: 10.21037/atm.2020.04.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Passive leg raising (PLR) test, known as reversible increasing venous return, could predict hemodynamic intolerance induced by renal replacement therapy (RRT). Oppositely, blood drainage procedure at the start of RRT cuts down intravascular capacity which is likely to have changes in fluid responsiveness has been little studied. Our study aimed to determine whether blood drainage procedure, defined as blood pump-out test, which is essential and inevitable at the beginning of RRT could predict fluid responsiveness in critically ill patients. Methods Critically ill patients underwent RRT with pulse contour analysis were included. During PLR, an increase of cardiac output (CO, derived from pulse contour analysis) ≥10% compared to baseline was considered responders as the gold standard. BPT was performed at a constant speed after the increase of CO induced by PLR returned to baseline and the maximal of CO within 2 minutes was recorded. Then area under ROC curve of CO changes to identify responders from non-responders in BPT was calculated based on the results from PLR test. Results Sixty-five patients were enrolled. Thirty-one/sixty-five patients (47.7%) were considered responders during PLR. And after analysis by ROC curve, a decrease in CO greater than 11.0% during BPT predicted fluid responsiveness with 70.9% sensitivity and 76.5% specificity. The highest area under the curve (AUC) was found for an increase in CO (0.74±0.06; 95% CI: 0.62 to 0.84). Conclusions BPT could be a supplement to PLR, providing a novel maneuver to predict fluid responsiveness in critically ill patients underwent RRT. (Trial registration: ChiCTR-DDD-17010534). Registered 30 January 2017 (retrospective registration).
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Affiliation(s)
- Daozheng Huang
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences/Guangdong Provincial Geriatrics Institute, Guangzhou 510080, China.,Department of Cardiology, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences/Guangdong Provincial Cardiovascular Institute, Guangzhou 510080, China
| | - Huan Ma
- Department of Cardiology, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences/Guangdong Provincial Cardiovascular Institute, Guangzhou 510080, China
| | - Jie Ma
- Department of Critical Care Medicine, Jiangmen Central Hospital, Jiangmen 529000, China
| | - Liyan Hong
- Department of Critical Care Medicine, Changjiang County People's Hospital, Changjiang 572700, China
| | - Xingji Lian
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yanhua Wu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yan Wu
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences/Guangdong Provincial Geriatrics Institute, Guangzhou 510080, China
| | - Shouhong Wang
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences/Guangdong Provincial Geriatrics Institute, Guangzhou 510080, China
| | - Tiehe Qin
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences/Guangdong Provincial Geriatrics Institute, Guangzhou 510080, China
| | - Ning Tan
- Department of Cardiology, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences/Guangdong Provincial Cardiovascular Institute, Guangzhou 510080, China
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McGregor D, Sharma S, Gupta S, Ahmed S, Harris T. Emergency department non-invasive cardiac output study (EDNICO): an accuracy study. Scand J Trauma Resusc Emerg Med 2020; 28:8. [PMID: 32005274 PMCID: PMC6995135 DOI: 10.1186/s13049-020-0704-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 01/19/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND There is little published data investigating non-invasive cardiac output monitoring in the emergency department (ED). We assess here the accuracy of five non-invasive methods in detecting fluid responsiveness in the ED: (1) common carotid artery blood flow, (2) suprasternal aortic Doppler, (3) bioreactance, (4) plethysmography with digital vascular unloading method, and (5) inferior vena cava collapsibility index. Left ventricular outflow tract echocardiography derived velocity time integral is the reference standard. This follows an assessment of feasibility and repeatability of these methods in the same cohort of ED patients. METHODS This is a prospective observational study of non-invasive methods for assessing fluid responsiveness in the ED. Participants were non-ventilated ED adult patients requiring intravenous fluid resuscitation. Sensitivity and specificity of each method in determining the fluid responsiveness status of participants is determined in comparison to the reference standard. RESULTS Thirty-three patient data sets were included for analysis. The specificity and sensitivity to detect fluid responders was 46.2 and 45% for common carotid artery blood flow (CCABF), 61.5 and 63.2% for suprasternal artery Doppler (SSAD), 46.2 and 50% for bioreactance, 50 and 41.2% for plethysmography vascular unloading technique (PVUT), and 63.6 and 47.4% for inferior vena cava collapsibility index (IVCCI), respectively. Analysis of agreement with Cohen's Kappa - 0.08 for CCABF, 0.24 for SSAD, - 0.04 for bioreactance, - 0.08 for PVUT, and 0.1 for IVCCI. CONCLUSION In this study, non-invasive methods were not found to reliably identify fluid responders. Non-invasive methods of identifying fluid responders are likely to play a key role in improving patient outcome in the ED in fluid depleted states such as sepsis. These results have implications for future studies assessing the accuracy of such methods.
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Affiliation(s)
- David McGregor
- Queen Mary University London and Barts Health NHS Trust, London, UK.
| | - Shrey Sharma
- University of Western Australia School of Medicine and Pharmacology, Perth, Australia
| | - Saksham Gupta
- University of Western Australia School of Medicine and Pharmacology, Perth, Australia
| | - Shanaz Ahmed
- Emergency Department Research Group, Royal London Hospital, London, UK
| | - Tim Harris
- Queen Mary University London and Barts Health NHS Trust, London, UK
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