Carotid ultrasound measurements for assessing fluid responsiveness in spontaneously breathing patients: corrected flow time and respirophasic variation in blood flow peak velocity

Kim, Do Hyeong; Shin, Seokyung; Kim, N.; Choi, Tae Kyung; Choi, Sun Ha; Choi, Yoon Seong

doi:10.1016/j.bja.2017.12.047

Cited by 60 publications

(102 citation statements)

References 40 publications

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“…However, the gray‐zone analysis, with boundaries defined by the values associated with sensitivity of 90% and specificity of 90%, revealed that 50% of the patients were in the gray zone, limiting its usability in clinical practice. We found that the ðV peak was a poor predictor of hypotension, as it is affected by patients’ respiratory effort and patterns …”

Section: Discussionmentioning

confidence: 99%

“…Hossein-Nejad et al 25 reported that the carotid artery cFT decreased with hemodialysis in patients with chronic kidney disease, and the change in the cFT correlated with the ultrafiltrate removed. In a prospective observational study, Kim et al 12 reported that the cFT predicted fluid responsiveness with an AUROC of 0.84 in patients undergoing neurosurgery under general anesthesia. 12 However, the best cutoff value for predicting fluid responsiveness was 349.4 milliseconds in their study.…”

Section: Discussionmentioning

confidence: 99%

“…The common carotid artery corrected flow time (cFT) and peak blood flow peak velocity variation (ðV peak ) are Doppler‐derived parameters, which have been used to identify volume‐responsive patients in different clinical scenarios . The cFT is defined as the time between the onset of systolic flow until closure of the aortic valve corrected for the HR and has been found to correlate with the intravascular volume.…”

mentioning

confidence: 99%

“…Carotid artery Doppler measurements have several advantages, such as they are noninvasive, and because the carotid artery is a superficial artery, it is technically easy to obtain measurements. The common carotid artery cFT is not affected by respiratory efforts; hence, it also can be used as a marker of volume responsiveness in spontaneously breathing patients . Similarly, the ðV peak has also be found to be a predictor of volume responsiveness in spontaneously breathing patients, although less useful than the cFT, as nearly 50% of the patients were in the gray‐zone range .…”

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confidence: 99%

“…10 The common carotid artery corrected flow time (cFT) and peak blood flow peak velocity variation (ðV peak ) are Doppler-derived parameters, which have been used to identify volume-responsive patients in different clinical scenarios. 11,12 The cFT is defined as the time between the onset of systolic flow until closure of the aortic valve corrected for the HR and has been found to correlate with the intravascular volume. Carotid artery Doppler measurements have several advantages, such as they are noninvasive, and because the carotid artery is a superficial artery, it is technically easy to obtain measurements.…”

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confidence: 99%

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Carotid Artery Corrected Flow Time and Respiratory Variations of Peak Blood Flow Velocity for Prediction of Hypotension After Induction of General Anesthesia in Adult Patients Undergoing Elective Surgery: A Prospective Observational Study

Maitra

Baidya

Anand

et al. 2019

J of Ultrasound Medicine

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Objectives Hypotension is common after induction of general anesthesia, and intraoperative hypotension is associated with postoperative end‐organ injury such as acute kidney injury and myocardial ischemia. This study was designed to determine the utility of the carotid corrected flow time (cFT) and carotid artery peak blood flow velocity variation (ðVpeak) for prediction of hypotension after induction of general anesthesia. Methods Adult patients (n = 112) undergoing any elective surgery under general anesthesia who fasted for at least 6 to 8 hours were recruited in this prospective observational study. The common carotid artery cFT and ðVpeak were measured with ultrasound 10 minutes before induction of general anesthesia. After that, general anesthesia with propofol was used, and hemodynamic data were collected until 3 minutes after induction of anesthesia. Results The carotid cFT was significantly correlated with percentages of the fall in the systolic blood pressure at 2 minutes (P < .0001) and 3 minutes (P < .0001) and percentages of the fall in the mean arterial pressure at 1 minute (P = .0006), 2 minutes (P < .0001), and 3 minutes (P < .0001). The cFT was a predictor of hypotension after induction of general anesthesia, with an area under the receiver operating characteristic curve of 0.91. The best cutoff value obtained from this study was 330.2 milliseconds or less, which predicted postinduction hypotension with sensitivity and specificity of 85.7% and 96.8%, respectively. The ðVpeak was an inferior predictor of postinduction hypotension, with an area under the receiver operating characteristic curve of 0.68. The optimum cutoff value was 18.8%, with sensitivity and specificity of 61.9% and 67.4%. Conclusions The cFT measured in the common carotid artery is a reasonable predictor of hypotension after induction of general anesthesia in American Society of Anesthesiologists physical status I and II patients. Further studies are required to identify its role in high‐risk patients such as older groups and patients with cardiovascular diseases and also to identify interobserver and intraobserver variability of cFT and ðVpeak measurements.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Carotid Artery Corrected Flow Time and Respiratory Variations of Peak Blood Flow Velocity for Prediction of Hypotension After Induction of General Anesthesia in Adult Patients Undergoing Elective Surgery: A Prospective Observational Study

Maitra

Baidya

Anand

et al. 2019

J of Ultrasound Medicine

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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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Carotid Doppler Ultrasonography for Hemodynamic Assessment in Critically Ill Children

et al. 2021

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Carotid ultrasound measurements for assessing fluid responsiveness in spontaneously breathing patients: corrected flow time and respirophasic variation in blood flow peak velocity

Abstract: NCT 02843477.

Cited by 60 publications

References 40 publications

Carotid Artery Corrected Flow Time and Respiratory Variations of Peak Blood Flow Velocity for Prediction of Hypotension After Induction of General Anesthesia in Adult Patients Undergoing Elective Surgery: A Prospective Observational Study

Carotid Artery Corrected Flow Time and Respiratory Variations of Peak Blood Flow Velocity for Prediction of Hypotension After Induction of General Anesthesia in Adult Patients Undergoing Elective Surgery: A Prospective Observational Study

Carotid Ultrasound to Predict Fluid Responsiveness

Carotid Doppler Ultrasonography for Hemodynamic Assessment in Critically Ill Children

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