Changes in carotid flow time In guiding fluid resuscitation in septic patients

Document Type : Original Article

Authors

1 Critical Care Medicine Department , Faculty Of Medicine, Cairo University

2 Critical Care Department ,Faculity Of Medicine ,Beni-Suef University,Egypt

Abstract

The  goal of this study to use carotid ultrasonography to detect changes in carotid  flow time in comparison to echocardiography in assessment of changes in heart dynamics to assess changes in volume status before &after passive leg raising  in septic patients. We arranged patients into two groups ,Group one: fluid responder 18 paients (45.5%), Group two non-fluid responder :22 patients(54,5%) . Increase carotid flow time (CFT) by 7msec is cosidered fluid responsive, 10% increase in stroke volume to be fluid. The PLR test could assess fluid responsiveness with specificity 100% and sensitivity 95% with cut of 10.6% change in CO to predict fluid responsiveness.the study show a statistically significant moderate positive correlation between CCA  flow time (CFT) both after PLR and the percent of change in CO measured by echocardiography. An agreement analyses were formed, we concluded that an overall good agreement between carotid artery blood flow measurement and Doppler echocardiography measurement with P value < 0.001, so we can use this parameters to predict fluid responsiveness post PLR perform are promising tool for the evaluation of fluid responsiveness in critically ill septic patients ,The PLR maneuver has demonstrated excellent performance for predicting fluid responsiveness. It is simple to perform, but requires a reliable system of COP monitoring able to quantify the short-term changes.

Keywords

Main Subjects

References

  1. Estrada, C.A. and R. Murugan, Hydroxyethyl starch in severe sepsis: end of starch era? 2013, BioMed Central.
  2. Evans, T.W., International Consensus Conferences in Intensive Care Medicine: non-invasive positive pressure ventilation in acute respiratory failure. Intensive care medicine, 2001. 27(1): p. 166- 178..
  3. Feissel, M., I. Mangin, O. Ruyer, et al., Respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock. Chest, 2001. 119(3): p. 867- 873.
  4. Feissel, M., J.-L. Teboul, P. Merlani, et al., Plethysmographic dynamic indices predict fluid responsiveness in septic ventilated patients. Intensive care medicine, 2007. 33(6): p. 993-999.
  5. Feissel, M., R. Kalakhy, J. Badie, et al., Plethysmography variability index: a new fluid responsiveness parameter. Critical Care, 2009. 13(S1): p. P205.
  6. Fellahi, J.L., M.O. Fischer, A. Dalbera, et al., Can endotracheal bioimpedance cardiography assess hemodynamic response to passive leg raising following cardiac surgery? Ann Intensive Care2012. 2(1): 26
  7. Ferrer, R., 1. Martin-Loeches, G. Phillips, et al., Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program. Critical care medicine, 2014.42-p. 1749-1755.
  8. Finfer, S., J. Myburgh, and R. Bellomo, Intravenous fluid therapy in critically ill adults. Nature Reviews Nephrology, 2018, 1409): p. 541-557
  9. Futier, E., J.-M. Constantin, C. Paugam-Burtz, et al., A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. New England Journal of Medicine, 2013. 369(5): p. 428-437.
  10. Garcia-Alvarez, M., P. Marik, and R. Bellomo, Sepsis-associated hyperlactatemia Critical care, 2014. 18(5): p. 503.
  11. Gassner, M., K. Killu, Z. Bauman, et al., Feasibility of common carotid artery point of care ultrasound in cardiac outputmeasurements compared to invasive methods. J Ultrasound, 2015, 18(2): p. 127-33.
  12. Geerts, B., J. Maas, R. de Wilde, et al., Haemodynamic assessment in Dutch intensive care units. Neth J Crit Care, 2009. 13: p. 178-84
  13. Geerts, B., R. de Wilde, L. Aarts, et al., Pulse contour analysis to assess hemodynamic response to passive leg raising. Journal of cardiothoracic and vascular anesthesia, 2011. 25(1): p. 48-52.
  14. Geerts, B.F., J. Maas, R.B. de Wilde, et al., Arm occlusion pressure is a useful predictor of an increase in cardiac output after fluid loading following cardiac surgery. European Journal of Anaesthesiology (EJA), 2011. 28(11): p. 802-806.
  15. Geerts, B.F., L. van den Bergh, T. Stijnen, et al., Comprehensive review: is it better to use the Trendelenburg position or passive leg raising for the initial treatment of hypovolemia? Journal of clinical anesthesia, 2012, 24(8): p. 668-674.
  16. Geerts, B.F., L.P. Aarts, A.B. Groeneveld, et al., Predicting cardiac output responses to passive leg raising by a PEEP-induced increase in central venous pressure, in cardiac surgery patients. Br J Anaesth, 2011. 107(2): p. 150-6.
  17. Geerts, B.F., L.P. Aarts, and JR Jansen, Methods in pharmacologs: measurement of cardiac output British journal of clinical pharmacology, 2011. 71(3). p. 316-330.
  18. Giraud, R., N. Siegenthaler, and K. Bendjelid, The Meaning of Fluid Responsiveness, in Annual Update in Intensive Care and Emergency Medicine 2012. 2012, Springer. p. 393.401.
  19. Girotto, V., IL Teboul, A. Beurton, et al, Carorld and femoral Doppler do not allow the sessment of passive leg raising effects, Ann Intensive Care, 2018 (1) p. 07
  20. Guarracino, and Baldassarri, Transesophageal echocardiography in the OR and ICU. Minerva anestesiologica, 2009.75(9): p. 518.

 

Egyptian Journal of Medical Research
Volume 4, Issue 1
January 2023
Pages 21-31

Files

Share

How to cite

Statistics