Carotid Doppler ultrasound for non-invasive haemodynamic monitoring: a narrative review

Abstract

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. 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. 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. Furthermore, feasibility aspects, training requirements and technical developments of CDU are addressed. Finally, recommendations are provided to improve the quality and standardization of future research and clinical practice in this field. 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.

Quantitative assessment of carotid ultrasound diameter measurements in the operating room: a comparable analysis of long-axis versus rotated and tilted orientation

“…to alert physicians of an imminent cardiovascular insufficiency (Pinsky and Payen 2005). As a general remark, it should be noted that carotid US cannot be performed in patients with a short neck or low carotid bifurcation, as measurements should be performed 2 cm below the bifurcation (Suriani et al 2022). In the last decades, a shift has taken place from static to dynamic hemodynamic monitoring, and towards functional hemodynamic monitoring, in which the cardiovascular system is challenged to assess preload responsiveness (Pinsky and Payen 2005).…”

“…Carotid ultrasound (US) imaging is a commonly used diagnostic tool to assess stenosis and plaque (Aboyans et al 2018). Carotid US has also proven to be a useful tool for hemodynamic monitoring (Suriani et al 2022), e.g. by measuring blood flow (Gassner et al 2015), and has been investigated as a method for estimating blood pressure (Vermeersch et al 2008).…”

Age-specific Topology Minimization in a One-dimensional Model Describing Carotid Haemodynamics

“…The analysis of cUS velocity and diameter waveforms provides information about individual cardiovascular health (e.g., vascular ageing, haemodynamic status) [1], [2]. Such waveforms can be simulated using patientspecific 1D haemodynamic models, which are parameterized based on individual in-vivo measurements [3].…”

Predicting Fluid Responsiveness Using Carotid Ultrasound in Mechanically Ventilated Patients: A Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies

“…Most reviews and meta-analyses have analyzed both mechanically ventilated and spontaneously breathing patients. [34][35][36][37] As cardiovascular mechanics may differ between spontaneously breathing and positive pressure ventilated patients, 38 this mixing of patient cohorts likely confounds results and limits applicability. [34][35][36][37] The single systematic review and meta-analysis investigating solely mechanically ventilated adult patients is itself limited by a low number of included studies.…”

“…[34][35][36][37] As cardiovascular mechanics may differ between spontaneously breathing and positive pressure ventilated patients, 38 this mixing of patient cohorts likely confounds results and limits applicability. [34][35][36][37] The single systematic review and meta-analysis investigating solely mechanically ventilated adult patients is itself limited by a low number of included studies. 39 Since the 2018 publication of this review, 8 more relevant studies [40][41][42][43][44][45][46][47] have been performed.…”