Diagnostic Efficacy of Carotid Ultrasound for Predicting the Risk of Perioperative Hypotension or Fluid Responsiveness: A Meta-Analysis

Abstract

Despite the acceptance of carotid ultrasound for predicting patients’ fluid responsiveness in critical care and anesthesia, its efficacy for predicting hypotension and fluid responsiveness remains unclear in the perioperative setting. Electronic databases were searched from inception to May 2023 to identify observational studies focusing on the use of corrected blood flow time (FTc) and respirophasic variation in carotid artery blood flow peak velocity (ΔVpeak) for assessing the risks of hypotension and fluid responsiveness. Using FTc as a predictive tool (four studies), the analysis yielded a pooled sensitivity of 0.82 (95% confidence interval (CI): 0.72 to 0.89) and specificity of 0.94 (95% CI: 0.88 to 0.97) for the risk of hypotension (area under curve (AUC): 0.95). For fluid responsiveness, the sensitivity and specificity of FTc were 0.79 (95% CI: 0.72 to 0.84) and 0.81 (95% CI: 0.75 to 0.86), respectively (AUC: 0.87). In contrast, the use of ΔVpeak to predict the risk of fluid responsiveness showed a pooled sensitivity of 0.76 (95% CI: 0.63 to 0.85) and specificity of 0.74 (95% CI: 0.66 to 0.8) (AUC: 0.79). The current meta-analysis provides robust evidence supporting the high diagnostic accuracy of FTc in predicting perioperative hypotension and fluid responsiveness, which requires further studies for verification.

Preoperative Ultrasound for the Prediction of Postinduction Hypotension: A Systematic Review and Meta-Analysis

“…The carotid artery FTc is decided by ventricular preload, cardiac contractility, and systemic vascular resistance (SVR) [61]. One earlier meta-analysis [10] has shown that the carotid artery FTc has a high diagnostic accuracy for the prediction of PIH and fluid responsiveness. In our study, the result was similar, and the emergency surgery did not affect the accuracy of carotid artery FTc.…”

“…Many advanced monitoring methods are available to assess the fluid responsiveness and volume status, including pulse pressure variation (PPV), dynamic arterial elastance (Edyn), stroke volume variations (SVV), and measurements from ultrasound [7][8][9][10], but the former three are either invasive or limited under spontaneous breathing, and ultrasound is a safe, inexpensive, noninvasive, and real-time diagnostic technique with relatively low costs. Ultrasound was used before induction to evaluate the volume status and predict PIH in an increasing number of studies [9][10][11]. However, the results are conflicting, given the various monitored parameters from ultrasound in different studies [12][13][14].…”