Ultrasound Assessment of the Change in Carotid Corrected Flow Time in Fluid Responsiveness in Undifferentiated Shock

Barjaktarević, Igor; Toppen, William; Hu, Shishan; Montoya, Elizabeth Aquije; Ong, Stephanie L.; Buhr, Russell G.; David, Ian J; Wang, Tisha; Rezayat, Talayeh; Chang, Shoou‐Yuh; Elashoff, David; Markovic, Daniela; Berlin, David; Cannesson, Maxime

doi:10.1097/ccm.0000000000003356

Cited by 79 publications

(106 citation statements)

References 50 publications

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“…Four hundred sixty‐five articles were found through the systematic search. Of these, 17 were determined to meet inclusion for the study (Figure ) . A total of 956 patients were included in the identified studies.…”

Section: Resultsmentioning

confidence: 99%

“…These studies evaluated at least 1, but occasionally more, carotid artery ultrasound measurement in relation to volume status. The most commonly used carotid measure was corrected flow time (FTc; 9 of 17 [53%]) . These studies recorded either absolute values or the absolute change and relative percentage change of FTc after PLR.…”

Section: Resultsmentioning

confidence: 99%

“…Other measures included CBF (4 of 17 [24%]), peak velocity or change in peak velocity with respiration (ΔCDPV; 6 of 17 [35%]), and carotid diameter (2 of 17 [12%]) . Most studies were done in either intensive care unit (ICU; 7 of 17 [41%]) or operating theater (3 of 17 [18%]) patients, although a large number were also done in healthy participants (4 of 17 [24%]) . Studies commonly used PLR (11 of 17 [65%]) or an intravenous fluid bolus (8 of 17 [47%]) as the fluid challenge.…”

Section: Resultsmentioning

confidence: 99%

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Carotid Ultrasound to Predict Fluid Responsiveness

Beier

Davis

Esener

et al. 2020

J of Ultrasound Medicine

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Objectives-To perform a systematic review of the accuracy of carotid ultrasound measures in determining volume responsiveness in adults. Methods-We conducted a systematic review of Ovid MEDLINE and Scopus from conception until January 1, 2019. Two independent reviewers used an iterative process to identify relevant articles and abstract information from them. The quality and risk of bias were assessed with the Quality Assessment of Diagnostic Accuracy Studies version 2 tool. Results-We identified 17 relevant articles with 956 patients. The 2 most frequently cited carotid measures of fluid responsiveness were corrected flow time and peak velocity or change in peak velocity with respiration (ΔCDPV). Accordingly, the diagnostic characteristics of corrected flow time in these studies varied widely, with sensitivities from 60% to 73%, specificities from 82% to 92%, and areas under the receiver operating characteristic curves from 0.75 to 0.88. Optimal cutoff values for ΔCDPV ranged from 9.1% to 14%, with areas under the receiver operating characteristic curves from 0.81 to 0.91, sensitivities from 73% to 86%, and specificities from 78% to 86%. Other measures, such as carotid blood flow and carotid diameter, had limited data to support their use. Heterogeneity of the studies prohibited a meta-analysis. Most studies had a moderate risk of bias and high applicability. Conclusions-Preliminary research suggests that carotid ultrasound measures may be useful adjunct measures of fluid status; however, they should not be interpreted as absolute and should be placed in a clinical context. The most welldefined and supported measure currently is ΔCDPV, with cutoffs from 9% to 14%. Corrected flow time shows promise, because of heterogeneity of how this value is measured, an optimal cutoff has not been established.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Carotid Ultrasound to Predict Fluid Responsiveness

Beier

Davis

Esener

et al. 2020

J of Ultrasound Medicine

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“…A recent study found that measuring changes in pulse pressure variation or stroke volume variation that occur when increasing tidal volume from 6 mL/kg predicted body weight to 8 mL/kg may add value in predicting fluid responsiveness [62]. Ultrasound measurements that predict fluid responsiveness include global end-diastolic volume index [63], velocity time integral of the Doppler signal across the left ventricular outflow tract [64,65], and carotid artery flow [66]. Respiratory variation in inferior vena cava diameter is a commonly used measurement, but a recent meta-analysis suggested limited ability to predict fluid responsiveness, particularly in spontaneously breathing patients [67].…”

Section: How Much Fluid To Givementioning

confidence: 99%

Resuscitation fluids

Casey

Brown

Semler

2018

Current Opinion in Critical Care

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Purpose of the Review: Intravenous fluid administration is a fundamental therapy in critical care, yet key questions remain unanswered regarding optimal fluid composition and dose. This review evaluates recent evidence regarding the effects of fluid resuscitation on pathophysiology, organ function, and clinical outcomes for critically ill patients. Recent findings: Recent findings suggest that intravenous fluid composition affects risk of kidney injury and death for critically ill adults. Generally, the risk of kidney injury and death appears to be greater with semisyntheic colloids compared to crystalloids, and with saline compared to balanced crystalloids. Whether a liberal, restrictive, or hemodynamic responsiveness-guided approach to fluid dosing improves outcomes during sepsis or major surgery remains uncertain. Summary: As evidence on fluid resuscitation evolves, a reasonable approach would be to use primarily balanced crystalloids, consider 2–3 liters for initial fluid resuscitation of hypovolemic or distributive shock, and use measures of anticipated hemodynamic response to guide further fluid administration.

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“…Previous studies on CCABF were conducted on healthy volunteers [57,58], ICU patients [18,[59][60][61], and peri-operative patients [62,63]. To our knowledge no studies have investigated the accuracy of SSAD in identifying fluid responders in spontaneously breathing patients in any clinical setting.…”

Section: Discussionmentioning

confidence: 99%

Emergency department non-invasive cardiac output study (EDNICO): an accuracy study

McGregor

Sharma

Gupta

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: There is little published data investigating non-invasive cardiac output monitoring in the emergency department (ED). We assess here the accuracy of five non-invasive methods in detecting fluid responsiveness in the ED: (1) common carotid artery blood flow, (2) suprasternal aortic Doppler, (3) bioreactance, (4) plethysmography with digital vascular unloading method, and (5) inferior vena cava collapsibility index. Left ventricular outflow tract echocardiography derived velocity time integral is the reference standard. This follows an assessment of feasibility and repeatability of these methods in the same cohort of ED patients. Methods: This is a prospective observational study of non-invasive methods for assessing fluid responsiveness in the ED. Participants were non-ventilated ED adult patients requiring intravenous fluid resuscitation. Sensitivity and specificity of each method in determining the fluid responsiveness status of participants is determined in comparison to the reference standard. Results: Thirty-three patient data sets were included for analysis. The specificity and sensitivity to detect fluid responders was 46.2 and 45% for common carotid artery blood flow (CCABF), 61.5 and 63.2% for suprasternal artery Doppler (SSAD), 46.2 and 50% for bioreactance, 50 and 41.2% for plethysmography vascular unloading technique (PVUT), and 63.6 and 47.4% for inferior vena cava collapsibility index (IVCCI), respectively. Analysis of agreement with Cohen's Kappa − 0.08 for CCABF, 0.24 for SSAD, − 0.04 for bioreactance, − 0.08 for PVUT, and 0.1 for IVCCI. Conclusion: In this study, non-invasive methods were not found to reliably identify fluid responders. Non-invasive methods of identifying fluid responders are likely to play a key role in improving patient outcome in the ED in fluid depleted states such as sepsis. These results have implications for future studies assessing the accuracy of such methods.

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Ultrasound Assessment of the Change in Carotid Corrected Flow Time in Fluid Responsiveness in Undifferentiated Shock

Cited by 79 publications

References 50 publications

Carotid Ultrasound to Predict Fluid Responsiveness

Carotid Ultrasound to Predict Fluid Responsiveness

Resuscitation fluids

Emergency department non-invasive cardiac output study (EDNICO): an accuracy study

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