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Lipszyc AC, Walker SCD, Beech AP, Wilding H, Akhlaghi H. Predicting Fluid Responsiveness Using Carotid Ultrasound in Mechanically Ventilated Patients: A Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies. Anesth Analg 2024; 138:1174-1186. [PMID: 38289868 DOI: 10.1213/ane.0000000000006820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND A noninvasive and accurate method of determining fluid responsiveness in ventilated patients would help to mitigate unnecessary fluid administration. Although carotid ultrasound has been previously studied for this purpose, several studies have recently been published. We performed an updated systematic review and meta-analysis to evaluate the accuracy of carotid ultrasound as a tool to predict fluid responsiveness in ventilated patients. METHODS Studies eligible for review investigated the accuracy of carotid ultrasound parameters in predicting fluid responsiveness in ventilated patients, using sensitivity and specificity as markers of diagnostic accuracy (International Prospective Register of Systematic Reviews [PROSPERO] CRD42022380284). All included studies had to use an independent method of determining cardiac output and exclude spontaneously ventilated patients. Six bibliographic databases and 2 trial registries were searched. Medline, Embase, Emcare, APA PsycInfo, CINAHL, and the Cochrane Library were searched on November 4, 2022. Clinicaltrials.gov and Australian New Zealand Clinical Trials Registry were searched on February 24, 2023. Results were pooled, meta-analysis was conducted where possible, and hierarchical summary receiver operating characteristic models were used to compare carotid ultrasound parameters. Bias and evidence quality were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines. RESULTS Thirteen prospective clinical studies were included (n = 648 patients), representing 677 deliveries of volume expansion, with 378 episodes of fluid responsiveness (58.3%). A meta-analysis of change in carotid Doppler peak velocity (∆CDPV) yielded a sensitivity of 0.79 (95% confidence interval [CI], 0.74-0.84) and a specificity of 0.85 (95% CI, 0.76-0.90). Risk of bias relating to recruitment methodology, the independence of index testing to reference standards and exclusionary clinical criteria were evaluated. Overall quality of evidence was low. Study design heterogeneity, including a lack of clear parameter cutoffs, limited the generalizability of our results. CONCLUSIONS In this meta-analysis, we found that existing literature supports the ability of carotid ultrasound to predict fluid responsiveness in mechanically ventilated adults. ∆CDPV may be an accurate carotid parameter in certain contexts. Further high-quality studies with more homogenous designs are needed to further validate this technology.
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Affiliation(s)
- Adam C Lipszyc
- From the Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Samuel C D Walker
- Department of Emergency Medicine, St Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Medical Education, University of Melbourne, Melbourne, Victoria, Australia
| | - Alexander P Beech
- From the Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Helen Wilding
- Library Service, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Hamed Akhlaghi
- Department of Emergency Medicine, St Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Medical Education, University of Melbourne, Melbourne, Victoria, Australia
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Bilgili B, Saracoglu A, Saracoglu KT, Ratajczyk P, Kararmaz A. The Reliability of Carotid Artery Doppler Ultrasonography Indices in Predicting Fluid Responsiveness during Surgery for Geriatric Patients: A Prospective, Observational Study. Healthcare (Basel) 2024; 12:783. [PMID: 38610205 PMCID: PMC11011830 DOI: 10.3390/healthcare12070783] [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: 02/27/2024] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND The reliability of determining fluid responsiveness during surgery in geriatric patients is challenging. Our primary outcome was to determine the reliability of Corrected Flow Time (FTc) in predicting fluid responsiveness. METHODS Elderly patients undergoing major surgery under general anesthesia were included. Measurements of common carotid artery diameter, velocity time integral, and systolic flow time (FT) were performed before and after a fluid challenge. FTc and carotid blood flow (CBF) were subsequently calculated. RESULTS The median change in carotid diameter was significantly higher in the fluid-responder (R) compared to the non-responder (NR) (6.51% vs. 0.65%, p = 0.049). The median change in CBF was notably higher in R compared to NR (30.04% vs. 9.72%, p = 0.024). Prior to the fluid challenge, systolic FT was significantly shorter in R than NR (285 ms vs. 315 ms, p = 0.027), but after the fluid challenge, these measurements became comparable among the groups. The change in systolic FT was higher in R (15.38% vs. 7.49%, p = 0.027). FTc and the change in FTc exhibited similarities among the groups at all study time points. Receiver operating characteristic analysis demonstrated an area under the curve of 0.682 (95% CI: 0.509-0.855, p = 0.039) for carotid diameter, 0.710 (95% CI: 0.547-0.872, p = 0.011) for CBF, 0.706 (95% CI: 0.540-0.872, p = 0.015) for systolic FT, and 0.580 (95% CI = 0.389-0.770, p = 0.413) for FTc. CONCLUSIONS In geriatric patients, potential endothelial changes in the carotid artery may influence the dynamic markers of fluid responsiveness. Despite the demonstrated effectiveness of FTc in predicting fluid responsiveness in the general population, this study underscores the limited reliability of carotid Doppler ultrasonography indices for prediction in a geriatric patient population.
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Affiliation(s)
- Beliz Bilgili
- Department of Anesthesiology and Intensive Care, Marmara University Pendik Training and Research Hospital, 34899 Istanbul, Turkey; (B.B.); (A.K.)
| | - Ayten Saracoglu
- Department of Anesthesiology, Intensive Care and Perioperative Medicine, Aisha bint Hamad Al Attiah Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar;
- College of Medicine, Qatar University, Doha P.O. Box 2713, Qatar
| | - Kemal T. Saracoglu
- College of Medicine, Qatar University, Doha P.O. Box 2713, Qatar
- Department of Anesthesiology, Intensive Care and Perioperative Medicine, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | - Pawel Ratajczyk
- Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, 90-419 Lodz, Poland
| | - Alper Kararmaz
- Department of Anesthesiology and Intensive Care, Marmara University Pendik Training and Research Hospital, 34899 Istanbul, Turkey; (B.B.); (A.K.)
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Dai S, Wang C, Tao X, Shen J, Xu L. Predicting fluid responsiveness in spontaneously breathing parturients undergoing caesarean section via carotid artery blood flow and velocity time integral measured by carotid ultrasound: a prospective cohort study. BMC Pregnancy Childbirth 2024; 24:60. [PMID: 38216901 PMCID: PMC10785346 DOI: 10.1186/s12884-024-06246-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/01/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Present evidence suggests that the Doppler ultrasonographic indices, such as carotid artery blood flow (CABF) and velocity time integral (VTI), had the ability to predict fluid responsiveness in non-obstetric patients. The purpose of this study was to assess their capacity to predict fluid responsiveness in spontaneous breathing parturients undergoing caesarean section and to determine the effect of detecting and management of hypovolemia (fluid responsiveness) on the incidence of hypotension after anaesthesia. METHODS A total of 72 full term singleton parturients undergoing elective caesarean section were enrolled in this study. CABF, VTI, and hemodynamic parameters were recorded before and after fluid challenge and assessed by carotid artery ultrasonography. Fluid responsiveness was defined as an increase in stroke volume index (SVI) of 15% or more after the fluid challenge. RESULTS Thirty-one (43%) patients were fluid responders. The area under the ROC curve to predict fluid responsiveness for CABF and VTI were 0.803 (95% CI, 0.701-0.905) and 0.821 (95% CI, 0.720-0.922). The optimal cut-off values of CABF and VTI for fluid responsiveness was 175.9 ml/min (sensitivity of 74.0%; specificity of 78.0%) and 8.7 cm/s (sensitivity of 67.0%; specificity of 90.0%). The grey zone for CABF and VTI were 114.2-175.9 ml/min and 6.8-8.7 cm/s. The incidence of hypotension after the combined spinal-epidural anaesthesia (CSEA) was significantly higher in the Responders group 25.8% (8/31) than in the Non-Responders group 17.1(7/41) (P < 0.001). The total incidence of hypotension after CSEA of the two groups was 20.8% (15/72). CONCLUSIONS Ultrasound evaluation of CABF and VTI seem to be the feasible parameters to predict fluid responsiveness in parturients undergoing elective caesarean section and detecting and management of hypovolemia (fluid responsiveness) could significantly decrease incidence of hypotension after anaesthesia. TRIAL REGISTRATION The trial was registered at the Chinese Clinical Trial Registry (ChiCTR) ( www.chictr.org ), registration number was ChiCTR1900022327 (The website link: https://www.chictr.org.cn/showproj.html?proj=37271 ) and the date of trial registration was in April 5, 2019. This study was performed in accordance with the Declaration of Helsinki and approved by the Research Ethics Committee of Women's Hospital, Zhejiang University School of Medicine (20,180,120).
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Affiliation(s)
- Shaobing Dai
- Department of Anaesthesiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Chun Wang
- Department of Anaesthesiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Xia Tao
- Department of Ultrasound, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Jianjun Shen
- Department of Anaesthesiology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Lili Xu
- Department of Anaesthesiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, Zhejiang Province, China.
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Jin G, Liu F, Yang Y, Chen J, Wen Q, Wang Y, Yu L, He J. Carotid blood flow changes following a simulated end-inspiratory occlusion maneuver measured by ultrasound can predict hypotension after the induction of general anesthesia: an observational study. BMC Anesthesiol 2024; 24:13. [PMID: 38172775 PMCID: PMC10763470 DOI: 10.1186/s12871-023-02393-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The primary purpose of this study was to investigate the predictive value of alterations in cervical artery hemodynamic parameters induced by a simulated end-inspiratory occlusion test (sEIOT) measured by ultrasound for predicting postinduction hypotension (PIH) during general anesthesia. METHODS Patients undergoing gastrointestinal tumor resection under general anesthesia were selected for this study. Ultrasound has been utilized to assess hemodynamic parameters in carotid artery blood flow before induction, specifically focusing on variations in corrected flow time (ΔFTc) and peak blood flow velocity (ΔCDPV), both before and after sEIOT. Anesthesia was induced by midazolam, sufentanil, propofol, and rocuronium, and blood pressure (BP) and heart rate (HR) were recorded within the first 10 min following endotracheal intubation. PIH was defined as fall in systolic blood pressure (SBP) or mean arterial pressure (MAP) by > 30% of baseline or MAP to < 60 mm Hg. RESULTS The area under the receiver operating characteristic curves (AUC) for carotid artery ΔFTc was 0.88 (95%CI, 0.81 to 0.96; P < 0.001), and the optimal cutoff value was -16.57%, with a sensitivity of 91.4% and specificity of 77.60%. The gray zone for carotid artery ΔFTc was -16.34% to -15.36% and included 14% of the patients. The AUC for ΔCDPV was 0.54, with an optimal cutoff value of -1.47%. The sensitivity and specificity were calculated as 55.20% and 57.10%, respectively. CONCLUSION The corrected blood flow time changes in the carotid artery induced by sEIOT can predict hypotension following general anesthesia-induced hypotension, wherein ΔFTc less than 16.57% is the threshold. TRIAL REGISTRATION Chinese Clinical Trial Registry ( www.chictr.org.cn ; 20/06/2023; ChiCTR2300072632).
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Affiliation(s)
- Guangshan Jin
- School of Anesthesiology, Xuzhou Medical University, Jiangsu, China
| | - Fuqiang Liu
- Department of Anesthesiology, Jiangsu Cancer Hospital, The Affricated Cancer Hospital of Nanjing Medical University, Jiangsu, China
| | - Yiwen Yang
- School of Anesthesiology, Xuzhou Medical University, Jiangsu, China
| | - Jiahui Chen
- School of Anesthesiology, Xuzhou Medical University, Jiangsu, China
| | - Qian Wen
- Department of Anesthesiology, Jiangsu Cancer Hospital, The Affricated Cancer Hospital of Nanjing Medical University, Jiangsu, China
| | - Yudong Wang
- School of Anesthesiology, Xuzhou Medical University, Jiangsu, China
| | - Ling Yu
- Department of Ultrasound, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu, China
| | - Jianhua He
- School of Anesthesiology, Xuzhou Medical University, Jiangsu, China.
- Department of Anesthesiology, Jiangsu Cancer Hospital, The Affricated Cancer Hospital of Nanjing Medical University, Jiangsu, China.
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Xie J, Wan J, Xu L, Zhang Y, Chen J. The Accuracy of Velocity-Time Integral Variation and Peak Velocity Variation of the Left Ventricular Outflow Tract in Predicting Fluid Responsiveness in Postoperative Patients Mechanically Ventilated at Low Tidal Volumes. J Cardiothorac Vasc Anesth 2023; 37:911-918. [PMID: 36931906 DOI: 10.1053/j.jvca.2023.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/16/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To assess whether velocity-time integral (VTI) variation and peak velocity (Vpeak) variation of the left ventricular outflow tract (LVOT) accurately could predict fluid responsiveness in postoperative critically ill patients mechanically ventilated at low tidal volumes. DESIGN A prospective, single-center, observational study. SETTING A surgical intensive care unit at a tertiary hospital. PARTICIPANTS Sixty postoperative critically ill patients with deep sedation and mechanical ventilation (tidal volume <8 mL/kg) were included in this study. INTERVENTIONS Passive leg raising (PLR). MEASUREMENT AND MAIN RESULTS Pulse pressure variation (PPV), VTI variation, and Vpeak variation were measured at baseline and after PLR by transthoracic echocardiography. The fluid responsiveness was defined as an increase (>10%) in stroke volume after PLR. Thirty-two (53.3%) patients were fluid responders. The areas under the receiver operating characteristic (AUROC) curves for PPV were 0.797, and the gray zone was large and included 58.3% of patients. Both VTI variation and Vpeak variation predicted fluid responsiveness with the AUROC of 0.919 and 0.905; meanwhile, the best cutoff values were 12.51% (sensitivity of 71.9%; specificity of 75.0%) and 11.76% (sensitivity of 81.3%; specificity of 89.3%). The gray zones of VTI variation and Vpeak variation were from 7.41% to 11.88% (contained 23.3% patients) and from 9.96% to 13.10% (contained 28.3% patients). CONCLUSIONS In postoperative critically ill patients mechanically ventilated with tidal volume <8 mL/kg, the VTI variation and Vpeak variation of LVOT accurately could predict fluid responsiveness, and VTI variation showed more accuracy than Vpeak variation in predicting fluid responsiveness.
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Affiliation(s)
- Jin Xie
- Intensive Care Unit of the Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jingjie Wan
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Li Xu
- Intensive Care Unit of the Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yukun Zhang
- Intensive Care Unit of the Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun Chen
- Intensive Care Unit of the Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China.
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Cavaliere F, Biancofiore G, Bignami E, DE Robertis E, Giannini A, Grasso S, McCREDIE VA, Piastra M, Scolletta S, Taccone FS, Terragni P. A year in review in Minerva Anestesiologica 2022: critical care. Minerva Anestesiol 2023; 89:115-124. [PMID: 36745125 DOI: 10.23736/s0375-9393.22.17211-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Franco Cavaliere
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy -
| | - Gianni Biancofiore
- Department of Transplant Anesthesia and Critical Care, University School of Medicine, Pisa, Italy
| | - Elena Bignami
- Division of Anesthesiology, Critical Care and Pain Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Edoardo DE Robertis
- Section of Anesthesia, Analgesia and Intensive Care, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Alberto Giannini
- Unit of Pediatric Anesthesia and Intensive Care, Children's Hospital - ASST Spedali Civili di Brescia, Brescia, Italy
| | - Salvatore Grasso
- Section of Anesthesiology and Intensive Care, Department of Emergency and Organ Transplantation, Polyclinic Hospital, Aldo Moro University, Bari, Italy
| | - Victoria A McCREDIE
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
| | - Marco Piastra
- Unit of Pediatric Intensive Care and Trauma Center, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Sabino Scolletta
- Department of Emergency-Urgency and Organ Transplantation, Anesthesia and Intensive Care, University Hospital of Siena, Siena, Italy
| | - Fabio S Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Pierpaolo Terragni
- Division of Anesthesia and General Intensive Care, Department of Medical, Surgical and Experimental Sciences, University Hospital of Sassari, University of Sassari, Sassari, Italy
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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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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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