Brachial artery peak velocity variation to predict fluid responsiveness in mechanically ventilated patients

Abstract

IntroductionAlthough several parameters have been proposed to predict the hemodynamic response to fluid expansion in critically ill patients, most of them are invasive or require the use of special monitoring devices. The aim of this study is to determine whether noninvasive evaluation of respiratory variation of brachial artery peak velocity flow measured using Doppler ultrasound could predict fluid responsiveness in mechanically ventilated patients.MethodsWe conducted a prospective clinical research in a 17-bed multidisciplinary ICU and included 38 mechanically ventilated patients for whom fluid administration was planned due to the presence of acute circulatory failure. Volume expansion (VE) was performed with 500 mL of a synthetic colloid. Patients were classified as responders if stroke volume index (SVi) increased ≥ 15% after VE. The respiratory variation in Vpeakbrach (ΔVpeakbrach) was calculated as the difference between maximum and minimum values of Vpeakbrach over a single respiratory cycle, divided by the mean of the two values and expressed as a percentage. Radial arterial pressure variation (ΔPPrad) and stroke volume variation measured using the FloTrac/Vigileo system (ΔSVVigileo), were also calculated.ResultsVE increased SVi by ≥ 15% in 19 patients (responders). At baseline, ΔVpeakbrach, ΔPPrad and ΔSVVigileo were significantly higher in responder than nonresponder patients [14 vs 8%; 18 vs. 5%; 13 vs 8%; P < 0.0001, respectively). A ΔVpeakbrach value >10% predicted fluid responsiveness with a sensitivity of 74% and a specificity of 95%. A ΔPPrad value >10% and a ΔSVVigileo >11% predicted volume responsiveness with a sensitivity of 95% and 79%, and a specificity of 95% and 89%, respectively.ConclusionsRespiratory variations in brachial artery peak velocity could be a feasible tool for the noninvasive assessment of fluid responsiveness in patients with mechanical ventilatory support and acute circulatory failure.Trial RegistrationClinicalTrials.gov ID: NCT00890071

Hemodynamic Changes during a Deep Inspiration Maneuver Predict Fluid Responsiveness in Spontaneously Breathing Patients

“…Although SB and mechanical ventilation have inversed physiological effects on cardiac preload, respiratory changes in SV or surrogates are correlated with VE-induced changes in SV [4]. As previously described [4], the sensitivity of ΔVF and ΔPP in our study was lower than that in mechanically ventilated patients [19, 22]. Nevertheless, the predictive value of ΔPP in mechanically ventilated patients can be altered when tidal volume is low [14].…”

Prediction of fluid responsiveness: an update

“…The reliability of the latter index is likely lower in the ICU patients than in the operating room patients [30] and in case of vasopressors administration [31, 32]. It has even been suggested that the variations of the peak velocity in the carotid [33] or brachial [34] arteries could reflect PPV and detect preload responsiveness.…”

Complications from Administration of Vasopressors Through Peripheral Venous Catheters: An Observational Study

“…Since the introduction of EGDT, the need for placement of a CVC in sepsis has come under increasing scrutiny. Alternative means of monitoring fluid responsiveness and adequacy of resuscitation that do not rely on central venous access RECEIVED: 19 May 2017; FINAL SUBMISSION RECEIVED: 22 August 2017; ACCEPTED: 14 September 2017 have been described (7)(8)(9)(10)(11)(12)(13)(14). The placement of a CVC has also been identified as a barrier to the implementation of EGDT, as it is a time-consuming procedure that cannot always be easily or safely performed in the ED (15,16).…”