Ultrasound assessment of volume responsiveness in critically ill surgical patients

Murthi, Sarah B.; Fatima, Syeda; Menne, Ashely R.; Glaser, Jacob; Galvagno, Samuel M.; Biederman, Stephen; Fang, Raymond; Chen, Hegang; Scalea, Thomas M.

doi:10.1097/ta.0000000000001331

Cited by 14 publications

(13 citation statements)

References 31 publications

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“…However, SVV monitoring is invasive and is difficult to implement generally in clinical practice due to its high cost and the need for specialized equipment. Recently, many investigators have used ultrasound technologyto guide perioperative fluid management [ 5 ]. New ultrasound indices are carotid corrected flow time (FTc) and respirophasic variation in carotid artery blood flow peak velocity (ΔVpeak) [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Correlation of carotid corrected flow time and respirophasic variation in blood flow peak velocity with stroke volume variation in elderly patients under general anaesthesia

et al. 2022

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Background Accurate assessment of volume responsiveness in elderly patients is important as it may reduce the risk of post-operative complications and enhance surgical recovery. This study evaluated the utility of two Doppler ultrasound-derived parameters, the carotid corrected flow time (FTc) and respirophasic variation in carotid artery blood flow peak velocity (ΔVpeak), to predict volume responsiveness in elderly patients under general anaesthesia. Methods A total of 97 elderly patients undergoing elective abdominal surgery under general anaesthesia were enrolled in this prospective observational study. After entering the operating room, all patients underwent radial artery puncture connected with a LiDCO device to measure stroke volume variation (SVV), and fluid therapy was performed after anaesthesia induction. Patients were classified as responders if SVV ≥ 13% before fluid challenge and nonresponders if SVV < 13%. The FTc, ΔVpeak, SVV and haemodynamic data were measured by ultrasound at baseline (T0) and before (T1) and after (T2) fluid challenge. The correlations between the Doppler ultrasound-derived parameters and SVV were analysed, and the receiver operating characteristic (ROC) curves was computed to characterize both FTc and ΔVpeak as measures of volume responsiveness in elderly patients. Results Forty-one (42.3%) patients were fluid responders. Carotid FTc before fluid challenge was negatively correlated with SVV before fluid challenge (r = -0.77; P < 0.01), and ΔVpeak was positively correlated with SVV (r = 0.72; P < 0.01). FTc and ΔVpeak predicted SVV ≥ 13% after general anaesthesia in elderly patients, with areas under the receiver operating characteristic curves (AUROCs) of 0.811 [95% confidence interval (CI), 0.721–0.900; P < 0.001] and 0.781 (95% CI, 0.686–0.875; P < 0.001), respectively. The optimal cut-off values of FTc and ΔVpeak to predict SVV ≥ 13% were 340.74 ms (sensitivity of 76.8%; specificity of 80.5%) and 11.69% (sensitivity of 78.0%; specificity of 67.9%), respectively. Conclusions There was a good correlation between carotid artery ultrasound parameters and SVV. FTc predicted fluid responsiveness better than ΔVpeak in elderly patients during general anaesthesia. Further study is needed before these parameters can be recommended for clinical application. Trial registration www.chictr.org.cn(ChiCTR2000031193); registered 23 March 2020.

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Section: Introductionmentioning

confidence: 99%

Correlation of carotid corrected flow time and respirophasic variation in blood flow peak velocity with stroke volume variation in elderly patients under general anaesthesia

et al. 2022

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“…Fluid responsiveness is defined as a 15% or greater increase in SV before and after an infusion (Murthi et al 2017). Patients were divided into two groups: responder group and non-responder group.…”

Section: Outcome Evaluationmentioning

confidence: 99%

Evaluation of Intravascular Volume Using the Internal Jugular Vein Cardiac Collapse Index in the Emergency Department: A Preliminary Prospective Observational Study

Nakano

Hashimoto

Mochizuki

et al. 2022

Ultrasound in Medicine & Biology

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“…Ultrasound was discussed as equally useful as laboratory testing as a measure of volume responsiveness in trauma patients by monitoring the vena cava and adjacent structures (158). In a clinically relevant heterogeneous population, ultrasound was only moderately predictive of volume resuscitation requirements whereas the change in diameter of the inferior vena cava was not found to be predictive.…”

Section: Early Prediction Of Complicationsmentioning

confidence: 99%

Timing of major fracture care in polytrauma patients – An update on principles, parameters and strategies for 2020

Pape

Halvachizadeh

Leenen

et al. 2019

Injury

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Objectives Sustained changes in resuscitation and transfusion management have been observed since the turn of the millennium, along with an ongoing discussion of surgical management strategies. The aims of this study are threefold: a) to evaluate the objective changes in resuscitation and mass transfusion protocols undertaken in major level I trauma centers; b) to summarize the improvements in diagnostic options for early risk profiling in multiply injured patients and c) to assess the improvements in surgical treatment for acute major fractures in the multiply injured patient. Methods I. A systematic review of the literature (comprehensive search of the MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases) and a concomitant data base (from a single Level I center) analysis were performed. Two authors independently extracted data using a pre-designed form. A pooled analysis was performed to determine the changes in the management of polytraumatized patients after the change of the millennium. II. A data base from a level I trauma center was utilized to test any effects of treatment changes on outcome. Inclusion criteria: adult patients, ISS > 16, admission < less than 24 h post trauma. Exclusion: Oncological diseases, genetic disorders that affect the musculoskeletal system. Parameters evaluated were mortality, ICU stay, ICU complications (Sepsis, Pneumonia, Multiple organ failure). Results I. From the electronic databases, 5141 articles were deemed to be relevant. 169 articles met the inclusion criteria and a manual review of reference lists of key articles identified an additional 22 articles. II. Out of 3668 patients, 2694 (73.4%) were male, the mean ISS was 28.2 (SD 15.1), mean NISS was 37.2 points (SD 17.4 points) and the average length of stay was 17.0 days (SD 18.7 days) with a mean length of ICU stay of 8.2 days (SD 10.5 days), and a mean ventilation time of 5.1 days (SD 8.1 days). Both surgical management and nonsurgical strategies have changed over time. Damage control resuscitation, dynamic analyses of coagulopathy and lactate clearance proved to sharpen the view of the worsening trauma patient and facilitated the prevention of further complications. The subsequent surgical care has become safer and more balanced, avoiding overzealous initial surgeries, while performing early fixation, when patients are physiologically stable or rapidly improving. Severe chest trauma and soft tissue injuries require further evaluation. Conclusions Multiple changes in management (resuscitation, transfusion protocols and balanced surgical care) have taken place. Moreover, improvement in mortality rates and complications associated with several factors were also observed. These findings support the view that the management of polytrauma patients has been substantially improved over the past 3 decades.

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Ultrasound assessment of volume responsiveness in critically ill surgical patients

Abstract: Diagnostic test, level II.

Cited by 14 publications

References 31 publications

Correlation of carotid corrected flow time and respirophasic variation in blood flow peak velocity with stroke volume variation in elderly patients under general anaesthesia

Correlation of carotid corrected flow time and respirophasic variation in blood flow peak velocity with stroke volume variation in elderly patients under general anaesthesia

Evaluation of Intravascular Volume Using the Internal Jugular Vein Cardiac Collapse Index in the Emergency Department: A Preliminary Prospective Observational Study

Timing of major fracture care in polytrauma patients – An update on principles, parameters and strategies for 2020

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