Radial Artery Pulse Pressure Variation Correlates With Brachial Artery Peak Velocity Variation in Ventilated Subjects When Measured by Internal Medicine Residents Using Hand-Carried Ultrasound Devices

Brennan, J. Matthew; Blair, John E.; Hampole, Chetan V.; Goonewardena, Sascha N.; Vasaiwala, Samip; Shah, Dipak; Spencer, Kirk T.; Schmidt, Gregory A.

doi:10.1378/chest.06-1768

Cited by 33 publications

(28 citation statements)

References 33 publications

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“…Recently, Brennan and colleagues [7], using a hand-carried Doppler ultrasound at the bedside, demonstrated that respiratory variations in brachial artery peak velocity (ΔVpeak brach ), measured by clinicians with minimal ultrasound expertise, were closely correlated with radial artery pulse pressure variations (ΔPP rad ), a well-known parameter of fluid responsiveness. Moreover, a ΔVpeak brach value of 16% or more was highly predictive of a ΔPP rad of 13% or more (the usual ΔPP rad threshold value for discrimination between fluid responder and nonresponder patients), so ΔVpeak brach could be used as a noninvasive surrogate of LV stroke volume variation for assessing preload dependence in patients receiving controlled mechanical ventilation.…”

Section: Introductionmentioning

confidence: 99%

Brachial artery peak velocity variation to predict fluid responsiveness in mechanically ventilated patients

2009

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IntroductionAlthough several parameters have been proposed to predict the hemodynamic response to fluid expansion in critically ill patients, most of them are invasive or require the use of special monitoring devices. The aim of this study is to determine whether noninvasive evaluation of respiratory variation of brachial artery peak velocity flow measured using Doppler ultrasound could predict fluid responsiveness in mechanically ventilated patients.MethodsWe conducted a prospective clinical research in a 17-bed multidisciplinary ICU and included 38 mechanically ventilated patients for whom fluid administration was planned due to the presence of acute circulatory failure. Volume expansion (VE) was performed with 500 mL of a synthetic colloid. Patients were classified as responders if stroke volume index (SVi) increased ≥ 15% after VE. The respiratory variation in Vpeakbrach (ΔVpeakbrach) was calculated as the difference between maximum and minimum values of Vpeakbrach over a single respiratory cycle, divided by the mean of the two values and expressed as a percentage. Radial arterial pressure variation (ΔPPrad) and stroke volume variation measured using the FloTrac/Vigileo system (ΔSVVigileo), were also calculated.ResultsVE increased SVi by ≥ 15% in 19 patients (responders). At baseline, ΔVpeakbrach, ΔPPrad and ΔSVVigileo were significantly higher in responder than nonresponder patients [14 vs 8%; 18 vs. 5%; 13 vs 8%; P < 0.0001, respectively). A ΔVpeakbrach value >10% predicted fluid responsiveness with a sensitivity of 74% and a specificity of 95%. A ΔPPrad value >10% and a ΔSVVigileo >11% predicted volume responsiveness with a sensitivity of 95% and 79%, and a specificity of 95% and 89%, respectively.ConclusionsRespiratory variations in brachial artery peak velocity could be a feasible tool for the noninvasive assessment of fluid responsiveness in patients with mechanical ventilatory support and acute circulatory failure.Trial RegistrationClinicalTrials.gov ID: NCT00890071

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Section: Introductionmentioning

confidence: 99%

Brachial artery peak velocity variation to predict fluid responsiveness in mechanically ventilated patients

2009

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“…Some measurements may be challenging to acquire and subject to methodical error or inability to obtain images adequately parallel to the ultrasound plane. Hemodynamic measurements obtained with TEE compared to TD with a PAC have resulted in agreements ranging from good [79] to possessing "accuracy limitations" [80]. A significant source of this inconsistency may result from interoperator variability.…”

Section: Special Intraoperative Monitoringmentioning

confidence: 99%

Anesthesia for Thoracic Surgical Procedures

Tsai¹,

Moon²,

Vachhani³

et al. 2013

Principles and Practice of Cardiothoracic Surgery

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“…Brennan et al [28] evaluated critical care patients with an HCU device in an attempt to predict fluid responsiveness, a surrogate of volume status. In this study, medical residents used an HCU device to record the brachial artery Doppler signal in 30 critically ill ventilated patients.…”

Section: Bedside Assessment Of Volume Status With Handcarried Ultrasomentioning

confidence: 99%

Handcarried Echocardiography to Assess Hemodynamics in Acute Decompensated Heart Failure

Goonewardena

Spencer

2010

Curr Heart Fail Rep

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Heart failure is a major source of cardiovascular morbidity, including acute decompensations requiring hospitalization. Because most therapeutic interventions in acute heart failure target optimization of cardiac output and volume status, accurate assessment of these parameters at the point of care is critical to guide management. However, physician bedside assessments of left ventricular (LV) function and volume status have limited accuracy. Traditional echocardiographic platforms, while useful for assessing ventricular and valvular function and volume status, have limitations for bedside use or frequent serial evaluation. Handcarried cardiac ultrasound devices, with their substantially lower costs, portability, and ease of use, circumvent many of the limitations of traditional echocardiographic platforms. The diagnostic capabilities of handcarried devices provide the opportunity for ultrasound assessment of LV function and serial bedside evaluation of volume status in patients with acutely decompensated heart failure.

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Radial Artery Pulse Pressure Variation Correlates With Brachial Artery Peak Velocity Variation in Ventilated Subjects When Measured by Internal Medicine Residents Using Hand-Carried Ultrasound Devices

Cited by 33 publications

References 33 publications

Brachial artery peak velocity variation to predict fluid responsiveness in mechanically ventilated patients

Brachial artery peak velocity variation to predict fluid responsiveness in mechanically ventilated patients

Anesthesia for Thoracic Surgical Procedures

Handcarried Echocardiography to Assess Hemodynamics in Acute Decompensated Heart Failure

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