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Tang X, Liang J, Tan D, Chen Q, Zhou C, Yang T, Liu H. Value of carotid corrected flow time or changes value of FTc could be more useful in predicting fluid responsiveness in patients undergoing robot-assisted gynecologic surgery: a prospective observational study. Front Med (Lausanne) 2024; 11:1387433. [PMID: 38638936 PMCID: PMC11024293 DOI: 10.3389/fmed.2024.1387433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Background The aim of this study was to evaluate the ability of point-of-care Doppler ultrasound measurements of carotid corrected flow time and its changes induced by volume expansion to predict fluid responsiveness in patients undergoing robot-assisted gynecological surgery. Methods In this prospective study, carotid corrected flow time was measured using Doppler images of the common carotid artery before and after volume expansion. The stroke volume index at each time point was recorded using noninvasive cardiac output monitoring with MostCare. Of the 52 patients enrolled, 26 responded. Results The areas under the receiver operating characteristic curves of the carotid corrected flow time and changes in carotid corrected flow time induced by volume expansion were 0.82 and 0.67, respectively. Their optimal cut-off values were 357 and 19.5 ms, respectively. Conclusion Carotid corrected flow time was superior to changes in carotid corrected flow time induced by volume expansion for predicting fluid responsiveness in this population.
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Affiliation(s)
- Xixi Tang
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Jingqiu Liang
- Chongqing Cancer Multi-Omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Dongling Tan
- Department of Anesthesiology, People’s Hospital of Shizhu, Chongqing, China
| | - Qi Chen
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Chengfu Zhou
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Tingjun Yang
- Department of Anesthesiology, People’s Hospital of Shizhu, Chongqing, China
| | - Hongliang Liu
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
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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] [What about the content of this article? (0)] [Affiliation(s)] [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. Front Med Technol 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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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, Horner C, Elfarnawany M, Eibl AM, Eibl JK. Carotid Artery Corrected Flow Time Measured by Wearable Doppler Ultrasound Accurately Detects Changing Stroke Volume During the Passive Leg Raise in Ambulatory Volunteers. Front Biosci (Elite Ed) 2023; 15:12. [PMID: 37369572 DOI: 10.31083/j.fbe1502012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 02/25/2023] [Accepted: 03/16/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND The change in the corrected flow time of the common carotid artery (ccFTΔ) has been used as a surrogate of changing stroke volume (SVΔ) in the critically-ill. Thus, this relatively easy-to-obtain Doppler measure may help clinicians better define the intended effect of intravenous fluids. Yet the temporal evolution of SVΔ and ccFTΔ has not been reported in volunteers undergoing a passive leg raise (PLR). METHODS We recruited clinically-euvolemic, non-fasted, adult, volunteers in a local physiology lab to perform 2 PLR maneuvers, each separated by a 5 minute 'wash-out'. During each PLR, SV was measured by a non-invasive pulse contour analysis device. SV was temporally-synchronized with a wireless, wearable Doppler ultrasound worn over the common carotid artery that continuously measured ccFT. RESULTS 36 PLR maneuvers were obtained across 19 ambulatory volunteers. 8856 carotid Doppler cardiac cycles were analyzed. The ccFT increased nearly ubiquitously during the PLR and within 40-60 seconds of PLR onset; the rise in SV from the pulse contour device was more gradual. SVΔ by +5% and +10% were both detected by a +7% ccFTΔ with sensitivities, specificities and areas under the receiver operator curve of 59%, 95% and 0.77 (p < 0.001) and 66%, 76% and 0.73 (p < 0.001), respectively. CONCLUSIONS The ccFTΔ during the PLR in ambulatory volunteers was rapid and sustained. Within the limits of precision for detecting a clinically-significant rise in SV by a non-invasive pulse contour analysis device, simultaneously-acquired ccFT from a wireless, wearable ultrasound system was accurate at detecting 'preload responsiveness'.
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Affiliation(s)
- Jon-Émile S Kenny
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada
- Flosonics Medical, Toronto, ON M5V 2Y1, Canada
| | | | | | - Andrew M Eibl
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada
- Flosonics Medical, Toronto, ON M5V 2Y1, Canada
| | - Joseph K Eibl
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada
- Flosonics Medical, Toronto, ON M5V 2Y1, Canada
- Northern Ontario School of Medicine, Sudbury, ON P3E 2C6, Canada
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Budak AB. Correlation of carotid Doppler flowmetry with fluid responsiveness in mechanically ventilated patients undergoing coronary artery bypass grafting-A popular gray zone. J Card Surg 2022; 37:4425-4426. [PMID: 36229970 DOI: 10.1111/jocs.17029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/03/2022] [Indexed: 01/06/2023]
Abstract
The authors conducted a prospective, observational study to evaluate the correlation of fluid responsiveness with commonly used carotid Doppler-derived indices like carotid artery blood flow, carotid corrected flow time, respirophasic variation in carotid artery blood flow peak velocity in patients undergoing coronary artery bypass grafting. They claimed that altough only ΔVpeak demonstrated some predictive power with areas under receiver operating characteristic of 0.671, carotid Doppler ultrasound indices were found to be not dependable as a substitute for invasive methods to assess fluid responsiveness. The presence of studies advocating quite different sentiments in the literature regarding feasibility and reliability show that there is a long way gone and a long way to go.
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Affiliation(s)
- Ali Baran Budak
- Department of Cardiovascular Surgery, Ulus Liv Hospital, Istanbul, Turkey
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Wang H, Chen W, Cheng H, Liu C, Yao W, Ding F, Wang Y, Chen Y. VALUE OF CORRECTED FLOW TIME IN COMMON CAROTID ARTERY IN PREDICTING VOLUME RESPONSIVENESS UNDER MECHANICAL VENTILATION. Shock 2022; 58:28-33. [PMID: 35904148 PMCID: PMC9415202 DOI: 10.1097/shk.0000000000001959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/09/2022] [Accepted: 06/13/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Objective: The present study aimed to investigate whether corrected flow time (FTc) in common carotid artery could predict volume responsiveness under mechanical ventilation and to further explore whether the sensitivity and specificity would be influenced by positive end-expiratory pressure (PEEP). Methods: The first stage of this study included 80 patients from the general surgery department undergoing laparotomy. After induction of general anesthesia, FTc in the common carotid artery was measured when hemodynamic indicators, such as blood pressure, heart rate, and cardiac output (CO), were stabilized. Then, 7 mg/kg (ideal body weight) of hydroxyethyl starch 130/0.4 sodium chloride was rapidly infused from the peripheral venous system. The infusion was completed within 15 minutes, and hemodynamic indicators were measured again immediately to evaluate volume responsiveness. The patients with change rate of CO (ΔCO ≥15%) were categorized into the responsive (R) group, whereas those with ΔCO <15% were categorized into the nonresponsive group (NR) group. In the second stage, 29 patients undergoing laparotomy were included. After induction of general anesthesia, PEEP of 0, 5, and 10 cmH 2 O was applied sequentially. Corrected flow time and hemodynamic indicators were recorded. Then, 7 mg/g of hydroxyethyl starch 130/0.4 sodium chloride was rapidly infused for 15 minutes, after which PEEP of 0, 5, and 10 cmH 2 O was applied sequentially, and the indicators were measured again. The patients with FTc equal to or less than the threshold in the first stage were categorized into the R group, otherwise into the NR group. Results: In the first stage of the study, CO and FTc differed significantly between the 2 groups, before and after volume load ( P < 0.05). Mean arterial pressure in the R group was significantly different, whereas heart rate did not differ before and after fluid infusion. Also, heart rate and mean arterial pressure were not significantly different before and after fluid infusion in the NR group. The area under the receiver operating characteristic curve was 0.786 ± 0.056 (95% confidence interval, 0.676-0.896; P = 0.00) for FTc before infusing volume load for predicting volume responsiveness. In the second stage of the study, PEEP did not have significant effects on FTc ( F2, 56 = 1.930, P = 0.155), whereas volume load had statistically significant effects on FTc ( F1, 28 ) = 9.381, P < 0.05). Moreover, FTc differed significantly different before and after fluid infusion ( P < 0.05). The area under the receiver operating characteristic curve for FTc in predicting volume responsiveness was 0.921, 0.805, and 0.719 when PEEP was 0, 5, and 10 cmH 2 O ( P < 0.05), respectively, and the cutoff value of FTc for diagnosing volume responsiveness was 323.42 milliseconds, 326.69 milliseconds, and 312.03 milliseconds, respectively. Conclusion: Corrected flow time in the common carotid artery can predict volume responsiveness under mechanical ventilation, and the predictive performance is not influenced by PEEP. Clinical Trial Registration Clinical register number: ChicTR2000029519.
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Affiliation(s)
- Hongzhi Wang
- Division of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
| | - Wei Chen
- Division of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
| | - Hao Cheng
- Division of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
| | - Can Liu
- Division of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
| | - WeiDong Yao
- Division of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
| | - Fang Ding
- Division of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
| | - YuLong Wang
- Division of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
| | - Yongquan Chen
- Division of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
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Kenny JÉS, Barjaktarevic I, Mackenzie DC, Rola P, Haycock K, Eibl AM, Eibl JK. Inferring the Frank-Starling Curve From Simultaneous Venous and Arterial Doppler: Measurements From a Wireless, Wearable Ultrasound Patch. Front Med Technol 2022; 3:676995. [PMID: 35047930 PMCID: PMC8757733 DOI: 10.3389/fmedt.2021.676995] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 03/30/2021] [Indexed: 12/12/2022] Open
Abstract
The Frank–Starling relationship is a fundamental concept in cardiovascular physiology, relating change in cardiac filling to its output. Historically, this relationship has been measured by physiologists and clinicians using invasive monitoring tools, relating right atrial pressure (Pra) to stroke volume (SV) because the Pra-SV slope has therapeutic implications. For example, a critically ill patient with a flattened Pra-SV slope may have low Pra yet fail to increase SV following additional cardiac filling (e.g., intravenous fluids). Provocative maneuvers such as the passive leg raise (PLR) have been proposed to identify these “fluid non-responders”; however, simultaneously measuring cardiac filling and output via non-invasive methods like ultrasound is cumbersome during a PLR. In this Hypothesis and Theory submission, we suggest that a wearable Doppler ultrasound can infer the Pra-SV relationship by simultaneously capturing jugular venous and carotid arterial Doppler in real time. We propose that this method would confirm that low cardiac filling may associate with poor response to additional volume. Additionally, simultaneous assessment of venous filling and arterial output could help interpret and compare provocative maneuvers like the PLR because change in cardiac filling can be confirmed. If our hypothesis is confirmed with future investigation, wearable monitors capable of monitoring both variables of the Frank–Starling relation could be helpful in the ICU and other less acute patient settings.
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Affiliation(s)
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care, Department of Medicine, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA, United States
| | - David C Mackenzie
- Department of Emergency Medicine, Maine Medical Center, Portland, Maine.,Tufts University School of Medicine, Boston, MA, United States
| | - Philippe Rola
- Division of Intensive Care, Santa Cabrini Hospital, Montreal, QC, Canada
| | - Korbin Haycock
- Department of Emergency Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, United States
| | - Andrew M Eibl
- 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 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] [What about the content of this article? (0)] [Affiliation(s)] [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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11
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Kenny JS, Barjaktarevic I, Mackenzie DC, Elfarnawany M, Math ZYB, Eibl AM, Eibl JK, Kim CH, Johnson BD. Carotid Doppler Measurement Variability in Functional Hemodynamic Monitoring: An Analysis of 17,822 Cardiac Cycles. Crit Care Explor 2021; 3:e0439. [PMID: 34136821 DOI: 10.1097/CCE.0000000000000439] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Carotid Doppler ultrasound is used as a measure of fluid responsiveness, however, assessing change with statistical confidence requires an adequate beat sample size. The coefficient of variation helps quantify the number of cardiac cycles needed to adequately detect change during functional hemodynamic monitoring. DESIGN Prospective, observational, human model of hemorrhage and resuscitation. SETTING Human physiology laboratory at Mayo Clinic. SUBJECTS Healthy volunteers. INTERVENTIONS Lower body negative pressure. MEASUREMENTS AND MAIN RESULTS We measured the coefficient of variation of the carotid artery velocity time integral and corrected flow time during significant cardiac preload changes. Seventeen-thousand eight-hundred twenty-two cardiac cycles were analyzed. The median coefficient of variation of the carotid velocity time integral was 8.7% at baseline and 11.9% during lowest-tolerated lower body negative pressure stage. These values were 3.6% and 4.6%, respectively, for the corrected flow time. CONCLUSIONS The median coefficient of variation values measured in this large dataset indicates that at least 6 cardiac cycles should be averaged before and after an intervention when using the carotid artery as a functional hemodynamic measure.
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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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Kenny JS, Barjaktarevic I, Eibl AM, Parrotta M, Long BF, Eibl JK. A wearable carotid Doppler tracks changes in the descending aorta and stroke volume induced by end-inspiratory and end-expiratory occlusion: A pilot study. Health Sci Rep 2020; 3:e190. [PMID: 33033751 PMCID: PMC7534617 DOI: 10.1002/hsr2.190] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/28/2020] [Accepted: 08/18/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND AIMS To test the feasibility of a novel, wearable carotid Doppler ultrasound to track changes in cardiac output induced by end-inspiratory and end-expiratory occlusion tests. METHODS We observed the pattern of Doppler change of the common carotid artery during a simulated end-inspiratory and expiratory occlusion test (sEIOT/sEEOT) in 10, nonventilated, healthy subjects. Simultaneously, we measured the Doppler signal of the descending aorta using duplex ultrasound (Xario, Toshiba Medical Systems) and stroke volume (SV) using noninvasive pulse contour analysis (Clearsight, Edwards Lifesciences, Irvine, California). RESULTS During sEIOT, SV, maximum velocity time integral (VTI) of the descending aorta, and common carotid fell by 25.7% (P = .0131), 26.1% (P < .0001), and 18.5% (P < .0001), respectively. During sEEOT, SV, maximum VTI of the descending aorta, and common carotid rose by: 41.3% (P = .0051), 28.3% (P < .0001), and 41.6% (P < .0001), respectively. There was good correlation between change in aortic VTI and carotid VTI (r 2 = 0.79); SV and aortic VTI (r 2 = 0.82), and SV and carotid VTI (r 2 = 0.95).The coefficient of variation of the VTI measured by the Doppler patch was roughly 60% less than that of the duplex system. CONCLUSIONS The pattern of SV change induced by a sEIOT/sEEOT in nonmechanically ventilated volunteers is reflected in the common carotid artery and descending aorta. The VTI variability of the Doppler patch was less than that of the traditional, duplex Doppler.
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Affiliation(s)
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care, Department of MedicineDavid Geffen School of Medicine at UCLALos AngelesCalifornia
| | - Andrew M. Eibl
- Health Sciences North Research InstituteSudburyOntarioCanada
| | | | - Bradley F. Long
- Health Sciences North Research InstituteSudburyOntarioCanada
- Northern Ontario School of MedicineSudburyOntarioCanada
| | - Joseph K. Eibl
- Health Sciences North Research InstituteSudburyOntarioCanada
- Northern Ontario School of MedicineSudburyOntarioCanada
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Maitra S, Baidya DK, Anand RK, Subramanium R, Bhattacharjee S. Carotid Artery Corrected Flow Time and Respiratory Variations of Peak Blood Flow Velocity for Prediction of Hypotension After Induction of General Anesthesia in Adult Patients Undergoing Elective Surgery: A Prospective Observational Study. J Ultrasound Med 2020; 39:721-730. [PMID: 31647132 DOI: 10.1002/jum.15151] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/09/2019] [Accepted: 09/19/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Hypotension is common after induction of general anesthesia, and intraoperative hypotension is associated with postoperative end-organ injury such as acute kidney injury and myocardial ischemia. This study was designed to determine the utility of the carotid corrected flow time (cFT) and carotid artery peak blood flow velocity variation (ðVpeak ) for prediction of hypotension after induction of general anesthesia. METHODS Adult patients (n = 112) undergoing any elective surgery under general anesthesia who fasted for at least 6 to 8 hours were recruited in this prospective observational study. The common carotid artery cFT and ðVpeak were measured with ultrasound 10 minutes before induction of general anesthesia. After that, general anesthesia with propofol was used, and hemodynamic data were collected until 3 minutes after induction of anesthesia. RESULTS The carotid cFT was significantly correlated with percentages of the fall in the systolic blood pressure at 2 minutes (P < .0001) and 3 minutes (P < .0001) and percentages of the fall in the mean arterial pressure at 1 minute (P = .0006), 2 minutes (P < .0001), and 3 minutes (P < .0001). The cFT was a predictor of hypotension after induction of general anesthesia, with an area under the receiver operating characteristic curve of 0.91. The best cutoff value obtained from this study was 330.2 milliseconds or less, which predicted postinduction hypotension with sensitivity and specificity of 85.7% and 96.8%, respectively. The ðVpeak was an inferior predictor of postinduction hypotension, with an area under the receiver operating characteristic curve of 0.68. The optimum cutoff value was 18.8%, with sensitivity and specificity of 61.9% and 67.4%. CONCLUSIONS The cFT measured in the common carotid artery is a reasonable predictor of hypotension after induction of general anesthesia in American Society of Anesthesiologists physical status I and II patients. Further studies are required to identify its role in high-risk patients such as older groups and patients with cardiovascular diseases and also to identify interobserver and intraobserver variability of cFT and ðVpeak measurements.
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Affiliation(s)
- Souvik Maitra
- Department of Anesthesiology, Pain Medicine, and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Dalim K Baidya
- Department of Anesthesiology, Pain Medicine, and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul K Anand
- Department of Anesthesiology, Pain Medicine, and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeshwari Subramanium
- Department of Anesthesiology, Pain Medicine, and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Sulagna Bhattacharjee
- Department of Anesthesiology and Critical Care, Institute of Liver and Biliary Sciences, New Delhi, India
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Kenny JS, Barjaktarevic I, Eibl AM, Parrotta M, Long BF, Eibl JK, Michard F. A Carotid Doppler Patch Accurately Tracks Stroke Volume Changes During a Preload-Modifying Maneuver in Healthy Volunteers. Crit Care Explor 2020; 2:e0072. [PMID: 32166292 DOI: 10.1097/CCE.0000000000000072] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objectives: Detecting instantaneous stroke volume change in response to altered cardiac preload is the physiologic foundation for determining preload responsiveness. Design: Proof-of-concept physiology study. Setting: Research simulation laboratory. Subjects: Twelve healthy volunteers. Interventions: A wireless continuous wave Doppler ultrasound patch was used to measure carotid velocity time integral and carotid corrected flow time during a squat maneuver. The Doppler patch measurements were compared with simultaneous stroke volume measurements obtained from a noninvasive cardiac output monitor. Measurements and Main Results: From stand to squat, stroke volume increased by 24% while carotid velocity time integral and carotid corrected flow time increased by 32% and 9%, respectively. From squat to stand, stroke volume decreased by 13%, while carotid velocity time integral and carotid corrected flow time decreased by 24% and 10%, respectively. Both changes in carotid velocity time integral and corrected flow time were closely correlated with changes in stroke volume (r2 = 0.81 and 0.62, respectively). The four-quadrant plot found a 100% concordance rate between changes in stroke volume and both changes in carotid velocity time integral and changes in corrected flow time. A change in carotid velocity time integral greater than 15% predicted a change in stroke volume greater than 10% with a sensitivity of 95% and a specificity of 92%. A change in carotid corrected flow time greater than 4% predicted a change in stroke volume greater than 10% with a sensitivity of 90% and a specificity of 92%. Conclusions: In healthy volunteers, both carotid velocity time integral and carotid corrected flow time measured by a wireless Doppler patch were useful to track changes in stroke volume induced by a preload-modifying maneuver with high sensitivity and specificity.
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Maitra S, Bhattacharjee S, Baidya DK. Correlation Between Doppler Derived Carotid Artery Corrected Flow Time and Pressure Transducer Derived Radial Artery Corrected Flow Time: A Prospective Observational Study. Cardiovasc Eng Technol 2020; 11:128-133. [PMID: 31950349 DOI: 10.1007/s13239-020-00455-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/09/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Carotid artery corrected flow time (cFT) derived from Doppler USG is a known predictor of volume responsiveness. However, it can't be obtained continuously, and is operator dependent. In this prospective study, correlation between Doppler derived carotid artery cFT and pressure transducer derived radial artery cFT was evaluated in adult patients undergoing surgery under general anaesthesia. METHODS Doppler derived carotid artery cFT were obtained from n = 51 adult patients at n = 125 time points. Simultaneously, pressure transducer waveforms were saved at the time of measurement of carotid artery cFT. Later, images were analyzed by an image processing computer software; both pulse pressure variation and cFT were estimated from pressure transducer waveform. RESULTS Radial artery flow times measured by two independent observers, were significantly correlated (r2 = 0.99, p < 0.00001). Bland-Altman analysis found limits of agreement - 8.3 to 6.3 ms [mean difference (95% CI) - 0.98 (- 1.63, - 0.32)]. Doppler derived carotid artery cFT & pressure transducer derived radial artery cFT were also significantly correlated [r2 = 0.78, p < 0.0001]. However, radial artery cFT was significantly higher than carotid artery cFT [p < 0.0001, paired sample t test]. Radial artery cFT > 404.4 ms had an sensitivity and specificity of 87.34% and 85% respectively with a grey zone was between 393.7 and 417 ms to predict PPV ≥ 12%. CONCLUSION Pressure transducer derived radial artery cFT correlated with Doppler derived carotid artery cFT and may be a reasonable predictor of volume responsiveness. Further studies are required to confirm its role in various clinical scenario for prediction of volume responsiveness.
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Affiliation(s)
- Souvik Maitra
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Sulagna Bhattacharjee
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - Dalim K Baidya
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Cheng YW, Xu F, Li J. Identification of volume parameters monitored with a noninvasive ultrasonic cardiac output monitor for predicting fluid responsiveness in children after congenital heart disease surgery. Medicine (Baltimore) 2018; 97:e12289. [PMID: 30278500 PMCID: PMC6181535 DOI: 10.1097/md.0000000000012289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 08/16/2018] [Indexed: 01/23/2023] Open
Abstract
No previous study has used an ultrasonic cardiac output monitor (USCOM) to assess volume parameters, such as stroke volume variation (SVV), in order to predict the volume status and fluid responsivenes in children after congenital heart disease (CHD) surgery. The present prospective trial aimed to investigate the ability of SVV and corrected flow time (FTc), which were assessed with a USCOM, for predicting fluid responsiveness in children after CHD surgery.The study included 60 children who underwent elective CHD surgery. Data were collected after elective CHD surgery. After arrival at PICU, the continuous invasive blood pressure was monitored. Once the blood pressure (BP) decreased to the minimum value, 6% hydroxyethyl starch (130/0.4) was administered (10 mL/kg) over 30 minutes for volume expansion (VE). The USCOM was used to monitor the heart rate, central venous pressure, stroke volume index (SVI), cardiac index, SVV, FTc of the children before and after VE. Additionally, the SVI change (ΔSVI) was calculated, and the inotropic score (IS) was determined. Children with a ΔSVI ≥15% were considered responders, while the others were considered nonresponders. The children were also divided into IS ≤10 and IS >10 groups.Of the 60 children, 32 were responders and 28 were nonresponders. We found that only SVV was significantly correlated with ΔSVI (r = 0.42, P < .01). SVV could predict fluid responsiveness after surgery (area under the curve [AUC]: 0.776, P < .01), and the optimal threshold was 17.04% (sensitivity, 84.4%; specificity, 60.7%). Additionally, the SVV AUC was higher in the IS >10 group than in the IS ≤10 group (0.81 vs 0.73).SVV measured with a USCOM can be used to predict fluid responsiveness after CHD surgery in children. Additionally, the accuracy of SVV for predicting fluid responsiveness might be higher among patients with an IS >10 than among those with an IS ≤10.
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Affiliation(s)
- Yu-wei Cheng
- Department of Emergency of Children's Hospital of Chongqing Medical University
- Ministry of Education Key Laboratory of Child Development and Disorders
- Key Laboratory of Pediatrics in Chongqing
- Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Feng Xu
- Department of PICU of Children's Hospital of Chongqing Medical University
- Ministry of Education Key Laboratory of Child Development and Disorders
- Key Laboratory of Pediatrics in Chongqing
- Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Jing Li
- Department of PICU of Children's Hospital of Chongqing Medical University
- Ministry of Education Key Laboratory of Child Development and Disorders
- Key Laboratory of Pediatrics in Chongqing
- Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
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