Respiratory Variations in Peak Peripheral Artery Velocities and Waveforms for Rapid Assessment of Fluid Responsiveness in Traumatic Shock Patients

Zhang, Qian; Shi, Xiu-Rong; Yi, Shuhua; Wan, Jian; Ju, Xuan; Su, Xi; Fan, Chengcheng; Lu, Xinyuan; Sun, Jie; Duan, Liang; Lin, Zongming; Liu, Jinlong

doi:10.12659/msm.928804

Cited by 2 publications

(19 citation statements)

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“…Two subgroups of the Roehrig et al 68 study could not be utilized for statistical analysis as the sensitivity and specificity values were not provided. Six different carotid parameters were identified, in descending frequency of use [number of subgroups in parentheses] these were as follows: corrected flow time (FTc) [9], 40,41,44 change in carotid Doppler peak velocity (∆CDPV) [9], 26,29,[41][42][43]47,[68][69][70] change in carotid artery velocity-time integral ∆CAVTI [4], 42,46 carotid Doppler peak velocity (CDPV) [2], 43,68 carotid Doppler flow (CDF) [1], 68 and change in corrected flow time ∆FTc [1]. 45 The method of obtaining carotid Doppler parameters is outlined well in existing literature.…”

Section: Study Selection and Study Characteristicsmentioning

confidence: 99%

“…Five different CO measures were used to identify fluid responders. In descending frequency of use [number of subgroups in parentheses], these were as follows: transthoracic echocardiography (TTE) velocitytime integral (VTI) [8], 42,43,46,47 PiCCO (PULSION Medical Systems AG) [6], 40,69,70 pulmonary artery catheter (PAC) [5], 26,29,68 FloTrac (Edwards Lifesciences) [5], 44,45 and LiDCO (LiDCO Ltd) [2]. 41 Six studies (15 subgroups) were conducted on surgical patie nts, 26,40,41,44,45,68 whereas 7 studies (11 subgroups) were conducted on intensive care patients.…”

Section: Study Selection and Study Characteristicsmentioning

confidence: 99%

“…41 Six studies (15 subgroups) were conducted on surgical patie nts, 26,40,41,44,45,68 whereas 7 studies (11 subgroups) were conducted on intensive care patients. 29,42,43,46,47,69,70 Four studies (8 subgroups) were conducted in the OT, 26,40,41,45 and the remaining 9 studies (18 subgroups) were conducted in the ICU. 29,[42][43][44]46,47,[68][69][70] All patients were mechanically ventilated with documented TV ranging from 6 to 10 mL/kg.…”

Section: Study Selection and Study Characteristicsmentioning

confidence: 99%

“…29,42,43,46,47,69,70 Four studies (8 subgroups) were conducted in the OT, 26,40,41,45 and the remaining 9 studies (18 subgroups) were conducted in the ICU. 29,[42][43][44]46,47,[68][69][70] All patients were mechanically ventilated with documented TV ranging from 6 to 10 mL/kg. Intravenous (IV) fluid administration was the most common method of increasing LV preload to determine fluid responsiveness.…”

Section: Study Selection and Study Characteristicsmentioning

confidence: 99%

“…[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.…”

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confidence: 99%

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

Lipszyc,

Walker,

Beech

et al. 2024

Anesthesia &Amp; Analgesia

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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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Section: Study Selection and Study Characteristicsmentioning

confidence: 99%

Section: Study Selection and Study Characteristicsmentioning

confidence: 99%

Section: Study Selection and Study Characteristicsmentioning

confidence: 99%

Section: Study Selection and Study Characteristicsmentioning

confidence: 99%

mentioning

confidence: 99%

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

Lipszyc,

Walker,

Beech

et al. 2024

Anesthesia &Amp; Analgesia

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Questioning the Role of Carotid Artery Ultrasound in Assessing Fluid Responsiveness in Critical Illness: A Systematic Review and Meta-Analysis

Walker,

Lipszyc,

Kilmurray

et al. 2024

Critical Care Research and Practice

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Background. A noninvasive and accurate method of identifying fluid responsiveness in hemodynamically unstable patients has long been sought by physicians. Carotid ultrasound (US) is one such modality previously canvassed for this purpose. The aim of this novel systematic review and meta-analysis is to investigate whether critically unwell patients who are requiring intravenous (IV) fluid resuscitation (fluid responders) can be identified accurately with carotid US. Methods. The protocol was registered with PROSPERO on the 30/11/2022 (ID number: CRD42022380284). Studies investigating carotid ultrasound accuracy in assessing fluid responsiveness in hemodynamically unstable patients were included. Studies were identified through searches of six databases, all run on 4 November 2022, Medline, Embase, Emcare, APA PsycInfo, CINAHL, and Cochrane Library. Risk of bias was assessed using the QUADAS-2 and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines. Results were pooled, meta-analysis was conducted where amenable, and hierarchical summary receiver operating characteristic models were established to compare carotid ultrasound measures. Results. Seventeen studies were included (n = 842), with 1048 fluid challenges. 441 (42.1%) were fluid responsive. Four different carotid US measures were investigated, including change in carotid doppler peak velocity (∆CDPV), carotid blood flow (CBF), change in carotid artery velocity time integral (∆CAVTI), and carotid flow time (CFT). Pooled carotid US had a pooled sensitivity, specificity, and AUROC with 95% confidence intervals (CI) of 0.73 (0.66–0.78), 0.82 (0.72–0.90), and 0.81 (0.78–0.85), respectively. ∆CDPV had sensitivity, specificity, and AUROC with 95% CI of 0.72 (0.64–0.80), 0.87 (0.73–0.94), and 0.82 (0.78–0.85), respectively. CBF had sensitivity, specificity, and AUROC with 95% CI of 0.70 (0.56–0.80), 0.80 (0.50–0.94), and 0.77 (0.78–0.85), respectively. Risk of bias and assessment was undertaken using the QUADAS-2 and GRADE tools. The QUADAS-2 found that studies generally had an unclear or high risk of bias but with low applicability concerns. The GRADE assessment showed that ∆CDPV and CBF had low accuracy for sensitivity and specificity. Conclusion. It appears that carotid US has a limited ability to predict fluid responsiveness in critically unwell patients. ∆CDPV demonstrates the greatest accuracy of all measures analyzed. Further high-quality studies using consistent study design would help confirm this.

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Respiratory Variations in Peak Peripheral Artery Velocities and Waveforms for Rapid Assessment of Fluid Responsiveness in Traumatic Shock Patients

Cited by 2 publications

References 5 publications

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

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

Questioning the Role of Carotid Artery Ultrasound in Assessing Fluid Responsiveness in Critical Illness: A Systematic Review and Meta-Analysis

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