Usefulness of peak flow variation in peripheral arteries for prediction of fluid responsiveness in critically ill patients compared to stroke volume variation

Document Type : Original papers

Authors

Critical care department, Faculty of medicine, Beni-Suef university, Egypt

Abstract

Background:-The aim of intravenous (IV) fluid load administration is to improve the tissue perfusion through increasing stroke volume (SV) and cardiac  output (COP). Patients in whome COP increased by ≥ 15% are called fluid responders and those account only 50% of hypotensive patients. ]1[
So it is very crucial to assess the fluid status of patients before fluid administration to distinguish between patients who may benefit and those who may not benefit or fluid administration is likely to be harmful in those patients. Objectives: to validate the diagnostic value of peak flow velocity in carotid artery by Doppler ultrasound in comparison to stroke volume variation (SVV) by velocity time integral (VTI) in assessment of fluid responsiveness in critically ill patients. Methods: This study is a prospective cohort study at the critical care department in Beni-Suef  university hospital ,we studied the effect of fluid challenge on 49 critically ill patients with hypotension (MAP<65mmHg). Carotid Doppler peak velocity (CDPV) and VTI measurements were obtained before and after fluid challenge. Fluid challenge responders were defined as patients whose SVV increased more than 10 % after fluid bolus by echocardiography . Results: ΔCDPV correlated significantly with an increase in SVV by VTI after fluid bolus. Area under the receiver-operator characteristic curve (AUC) of CDPV was 0.937 [95% confidence interval (CI) 0.858 – 1.00].
The optimal cut-off point of ΔCDPV for fluid responsiveness was 12.25% with a sensitivity and specificity of 90% and 94.7% respectively. Conclusion: Doppler assessment of carotid peak velocity seems to be a highly feasible and reliable method to predict fluid responsiveness in critically ill patients with hypotension (MAP> 65 mmHg)

Keywords

References

  1. Marik PE, Cavalazzi R, Vasu T, et al. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care 2009;37:2642–7.
  2. Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest. 2002;121:2000–8.
  3. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368–77.
  4. Holte K, Kehlet H. Fluid therapy and surgical outcomes in elective surgery: a need for reassessment in fast-track surgery. J Am Coll Surg. 2006;202:971–89.
  1. Wiedemann HP, Wheeler AP, Bernard GR, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354:2564–75.
  2. Boyd JH, Forbes J, Nakada TA, et al. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit CareMed. 2011;39:259–65.
  3. Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008;134(1):172–8.
  4. Osman D, Ridel C, Ray P, et al. Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge. Crit Care Med. 2008;35(1):64–8.
  5. Roehrig C, Govier M, Robinson J, et al. Carotid Doppler flowmetry correlates poorly with thermodilution cardiac output following cardiac surgery. Acta Anaesthesiol Scand. 2017;61(1):31–8.
  6. Brennan JM, Blair JE, Hampole C, et al. 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. Chest. 2007;131(5):1301–7.
  7. Monge García MI, Gil Cano A, Díaz Monrové JC. Brachial artery peak velocity variation to predict fluid responsiveness in mechanically ventilated patients.Crit Care. 2009;13(5):R142.
  8. Yin WH, Chen Y, Jin XD, et al. Measurement of peak velocity variation of common carotid artery with bedside ultrasound to estimate preload in surgery ICU. Sichuan Da Xue Xue Bao Yi Xue Ban. 2013;44(4):624–8.
  9. Song Y, Kwak YL, Song JW, et al. Respirophasic carotid artery peak velocity variation as a predictor of fluid responsiveness in mechanically ventilated patients with coronary artery disease. Br J Anaesth. 2014;113(1):61–6.
  10. Ibarra-Estrada MÁ, López-Pulgarín JA, Mijangos-Méndez JC,et al. Respiratory variation in carotid peak systolic velocity predicts volume responsiveness in mechanically ventilated patients with septic shock: a prospective cohort study. Crit Ultrasound J. 2015;7(1):29.
  11. Zhu W, Wan L, Wan X, et al. Measurement of brachial artery velocity variation and inferior vena cava variability to estimate fluid responsiveness. 2016;28(8):713-7
  12. Wang J, Zhou D, Gao Y, et al. Effect of VTILVOT variation rate on the assessment of fluid responsiveness in septic shock patients. Medicine. 2020;99(47).
  13. Vos JJ, Kalmar AF, Hendriks HG, et al. The effect of fluid resuscitation on the effective circulating volume in patients undergoing liver surgery: a post-hoc analysis of a randomized controlled trial. Journal of clinical monitoring and computing. 2018;32:73-80.
  14. Messina A, Bakker J, Chew M, et al. Pathophysiology of fluid administration in critically ill patients. Intensive Care Medicine Experimental. 2022;10(1):46.
  15. Kim D-H, Shin S, Kim N, et al. Carotid ultrasound measurements for assessing fluid responsiveness in spontaneously breathing patients: corrected flow time and respirophasic variation in blood flow peak velocity. British Journal of Anaesthesia. 2018;121(3):541-9
  16. Nianfang Lu 1, Li Jiang, Bo Zhu, et al. Variability of peripheral arterial peak velocity predicts fluid responsiveness in patients with septic shock. 2018;30(3):224-229.
  17. Yu Chen, Ziyou Liu, Jun Fang, et al. Correlation of carotid corrected flow time and respirophasic variation in blood flow peak velocity with stroke volume variation in elderly patients under general anaesthesia. 2022;22(1):246
  18. Yao B, Liu J-y, Sun Y-b. Respiratory variation in peripheral arterial blood flow peak velocity to predict fluid responsiveness in mechanically ventilated patients: a systematic review and meta-analysis. BMC anesthesiology. 2018;18(1):1-

Files

Share

How to cite

Statistics