Comparative study between suprasternal and apical windows: a user-friendly cardiac output measurement for the anesthesiologist

Souza, Rafaela Souto e; Melo, Wendhell Barros de; Freire, Cláudia Maria Vilas; Boas, Walkiria Wingester Vilas

doi:10.1016/j.bjane.2021.02.063

Cited by 4 publications

(4 citation statements)

References 28 publications

(43 reference statements)

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“…Recent studies have shown that echocardiographic measurements of aortic flow velocities via the suprasternal view could allow for improved access with high precision and have been shown to be easy to apply even for inexperienced operators. 12 Furthermore, if flow is measured in the descending aorta from the suprasternal view, it has the additional benefit of minimizing the Doppler angle error and potentially improving the accuracy further. 13 We, therefore, aimed to study a novel approach of predicting fluid responsiveness in children intraoperatively, in which the suprasternal notch window is used to measure respiratory variations in peak descending aortic flow (ΔVpeak dAo) with two-dimensional echocardiography.…”

Section: Introductionmentioning

confidence: 99%

“…TTE, although being less invasive, carries the drawback of limited access to the anterior chest wall. Recent studies have shown that echocardiographic measurements of aortic flow velocities via the suprasternal view could allow for improved access with high precision and have been shown to be easy to apply even for inexperienced operators 12 . Furthermore, if flow is measured in the descending aorta from the suprasternal view, it has the additional benefit of minimizing the Doppler angle error and potentially improving the accuracy further 13 .…”

Section: Introductionmentioning

confidence: 99%

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Assessment of fluid responsiveness in children using respiratory variations in descending aortic flow

Karlsson

Peters

Denault

et al. 2023

Acta Anaesthesiol Scand

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BackgroundThe primary aim of the current study was to investigate the ability of respiratory variations in descending aortic flow, measured with two‐dimensional echo at the suprasternal notch (ΔVpeak dAo), to predict fluid responsiveness in anesthetized mechanically ventilated children. In addition, variations in peak descending aortic flow measured with apical transthoracic echo (ΔVpeak LVOT) were examined for the same properties.MethodsTwenty‐seven patients under general anesthesia were investigated in this prospective observational study. Cardiac output, ΔVpeak dAo, and ΔVpeak LVOT were measured at stable conditions after anesthesia induction. The measurements were repeated after a 10 mL kg−1 fluid bolus. Patients were classified as responders if stroke volume index increased by >15% after fluid bolus. The ability of each parameter to predict fluid responsiveness was assessed using receiver operating characteristic curves.ResultsTwenty‐seven patients were analyzed, mean age and weight 43 months and 16 kg, respectively. Twelve responders and 15 non‐responders were identified. ΔVpeak dAo was significantly higher in the responder group (14%, 95% confidence interval [CI]: 12%–17%) compared to the non‐responder group (11%, 95% CI: 9%–13%) (p = .04) at baseline. Area under the ROC curve for ΔVpeak dAo and ΔVpeak LVOT was 0.73 (95% CI: 0.52–0.89, p = .02) and 0.56 (0.34–0.78, p = .3), respectively. A baseline level of ΔVpeak dAo of >14% predicted fluid responsiveness with a sensitivity of 58% (95% CI: 28%–85%) and specificity of 73% (95% CI: 45%–92%).ConclusionIn mechanically ventilated children, ΔVpeak dAo identified fluid responders with moderate diagnostic power in the current study. ΔVpeak LVOT failed to predict fluid responders in the current study.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessment of fluid responsiveness in children using respiratory variations in descending aortic flow

Karlsson

Peters

Denault

et al. 2023

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

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“…This issue of the Brazilian Journal of Anesthesiology discusses C-POCUS to assist hemodynamic monitoring, which is one of the pillars for indicating its clinical use. Souza et al 8 used the suprasternal window to obtain the velocity time integral (VTI) of the descending thoracic aorta as a surrogate of cardiac output and compared it with the conventional method of measurement obtained through the apical window. Their findings not only suggest a good correlation between windows, but also that the proposed technique can be learned with relative ease to be applied in the daily anesthetic practice.…”

mentioning

confidence: 99%

“…Regarding the general POCUS curriculum 1 , 2 , 3 , 4 , 5 , 6 and the specific domain of C-POCUS, 7 , 8 , 9 , 10 it is anticipated that anesthesiologists in training demonstrate the ability to: 13 , 14 Recognize the clinical indication of the test: resuscitation, hemodynamic monitoring, and assistance in performing procedures. Show basic knowledge of physics for image acquisition and what to do to optimize it.…”

mentioning

confidence: 99%