Dynamic Carotid Doppler Indices Predict Fluid Responsiveness in PostOperative Cardiac Patients

Main Article Content

Mohamed Hamdi Saleh
Mohamed Samir Ali
Khaled Abdel Azem Shoukry
Kamel Abdelaziz Abdullah

Keywords

Fluid reactivity, total carotid flow, and systolic carotid flow.

Abstract

Background: While it has been established that carotid blood flow (CBF) correlates significantly with stroke volume index (SVI), the accuracy of carotid flow Doppler indices in assessing fluid responsiveness in post-operative cardiac patients remains unknown.
Aim: to see if Fluid Responsiveness Can Be Predicted Using Dynamic Carotid Doppler Indices After Cardiac Surgery.
Patients and Methods: Research was done at Cairo University's critical care unit, which is part of the medical school. There were 70 patients admitted to the Surgical Intensive Care Unit in a row. Patients were divided into two groups: those who responded and those who did not.
Results: Δ total carotid flow, Δ systolic carotid flow, Δ corrected carotid flow time, and Δ HR % change were significantly higher among responder’s group than non-responder (16.47±3.73, 13.18±4.19, and 14.00±5.22 vs 8.44±2.74, 5.68±3.33, and 10.16±5.12, p value: <0.001, 0.001, and 0.004 respectively). Significant Pearson link between Δ SV% and Δ TCF, Δ SCF, and Δ corrected CFT (p value: 0.024, 0.039, and 0.026 respectively). Δ TCF% was most reliable indicator of fluid responsiveness with sensitivity 93.1%, and area below the curve (AUROC) was 0.946 (p=0.031).
Conclusion: Fluid responsiveness after cardiac surgery may be predicted with high accuracy using dynamic Doppler indices.

Abstract 296 | pdf Downloads 125

References

1. Boulain T, Boisrame-Helms J, Ehrmann S, et al. Volume expansion in the first 4 days of shock: a prospective multicentre study in 19 French intensive care units. Intensive Care Med 2015; 41: 248–56
2. Jones AE, Brown MD, Trzeciak S, et al. The effect of a quantitative resuscitation strategy on mortality in patients with sepsis: a meta-analysis. Crit Care Med 2008; 36: 2734–9
3. Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med 2011; 39: 259–65
4. Judson PI, Abhilash KPP, Pichamuthu K, Chandy GM. Evaluation of Carotid Flow Time to Assess Fluid Responsiveness in the Emergency Department. J Med Ultrasound. 2020 Oct 1; 29(2):99-104. doi: 10.4103/JMU.JMU_77_20. PMID: 34377640; PMCID: PMC8330669.
5. Marik PE, Levitov A, Young A, Andrews L. The use of bioreactance and carotid Doppler to determine volume responsiveness and blood flow redistribution following passive leg raising in hemodynamically unstable patients. Chest 2013; 143:364‑70.
6. Long E, Oakley E, Duke T, Babl FE. Does respiratory variation in inferior vena cava diameter predict fluid responsiveness: a systematic review and meta-analysis? Shock 2017; 47:550–559.
7. Marik PE, Levitov A, Young A, Andrews L. The use of bioreactance and carotid Doppler to determine volume responsiveness and blood flow redistribution following passive leg raising in hemodynamically unstable patients. Chest 2013; 143:364–370.
8. Girotto V, Teboul JL, Beurton A, Galarza L, Guedj T, Richard C et al. Carotid and femoral Doppler do not allow the assessment of passive leg raising effects. Ann Intensive Care 2018; 8:67.
9. Ma IWY, Caplin JD, Azad A, Wilson C, Fifer MA, Bagchi A et al. Correlation of carotid blood flow and corrected carotid flow time with
invasive cardiac output measurements. Crit Ultrasound J 2017; 9:10.
10. DiCorte CJ, Latham P, Greilich PE, Cooley MV, Grayburn PA, Jessen ME. Esophageal Doppler monitor determinations of cardiac output and preload during cardiac operations. Ann Thorac Surg 2000; 69:1782–1786.
11. Lee JH, Kim JT, Yoon SZ, et al. Evaluation of corrected flow time in oesophageal Doppler as a predictor of fluid responsiveness. Br J Anaesth 2007; 99:343–348.
12. Madan AK, UyBarreta VV, Aliabadi-Wahle S, et al. Esophageal doppler ultrasound monitor versus pulmonary artery catheter in the hemodynamic management of critically ill surgical patients.J Trauma 1999; 46:607–611.
13. Pare JR, Liu R, Moore CL, Safdar B. Corrected flow time: a noninvasive ultrasound measure to detect preload reduction by nitroglycerin. Am J Emerg Med 2016; 34:1859–1862.
14. Weber U, Glassford NJ, Eastwood GM, et al. A pilot assessment of carotid and brachial artery blood flow estimation usingultrasound Doppler in cardiac surgery patients. J Cardiothorac Vasc Anesth 2016; 30:141–148.
15. Blehar DJ, Glazier S, Gaspari RJ. Correlation of corrected flow time in the carotid artery with changes in intravascular volume status. J Crit Care 2014; 29: 486-8.
16. Jung, S.; Kim, J.; Na, S.; Nam, W.S.; Kim, D.-H. Ability of Carotid Corrected Flow Time to Predict Fluid Responsiveness in Patients Mechanically Ventilated Using Low Tidal Volume after Surgery. J. Clin. Med. 2021; 10 (12): 2676.
17. Dark, P.M.; Singer, M. The validity of transesophageal doppler ultrasonography as a measure of cardiac output in critically illadults. Intensiv. Care Med. 2004; 30: 2060–2066.
18. Judson PI, Abhilash KP, Pichamuthu K, Chandy GM. Evaluation of carotid flow time to assess fluid responsiveness in the emergency
department. J Med Ultrasound 2021; 29:99-104.