Y Song1, Y L Kwak2, J W Song1, Y J Kim3, J K Shim4. 1. Department of Anaesthesiology and Pain Medicine, Yonsei University Health System, 134, Shinchon-dong, Seodaemun-gu, Seoul 120-725, Republic of Korea Anaesthesia and Pain Research Institute, Yonsei University Health System, 134, Shinchon-dong, Seodaemun-gu, Seoul 120-725, Republic of Korea. 2. Department of Anaesthesiology and Pain Medicine, Yonsei University Health System, 134, Shinchon-dong, Seodaemun-gu, Seoul 120-725, Republic of Korea Anaesthesia and Pain Research Institute, Yonsei University Health System, 134, Shinchon-dong, Seodaemun-gu, Seoul 120-725, Republic of Korea Severance Biomedical Science Institute, Yonsei University, 134, Shinchon-dong, Seodaemun-gu, Seoul 120-725, Republic of Korea. 3. Department of Anaesthesiology and Pain Medicine, Yonsei University Health System, 134, Shinchon-dong, Seodaemun-gu, Seoul 120-725, Republic of Korea. 4. Department of Anaesthesiology and Pain Medicine, Yonsei University Health System, 134, Shinchon-dong, Seodaemun-gu, Seoul 120-725, Republic of Korea Anaesthesia and Pain Research Institute, Yonsei University Health System, 134, Shinchon-dong, Seodaemun-gu, Seoul 120-725, Republic of Korea aneshim@yuhs.ac.
Abstract
BACKGROUND: We studied respirophasic variation in carotid artery blood flow peak velocity (ΔVpeak-CA) measured by pulsed wave Doppler ultrasound as a predictor of fluid responsiveness in mechanically ventilated patients with coronary artery disease. METHODS: Forty patients undergoing elective coronary artery bypass surgery were enrolled. Subjects were classified as responders if stroke volume index (SVI) increased ≥15% after volume expansion (6 ml kg(-1)). The ΔVpeak-CA was calculated as the difference between the maximum and minimum values of peak velocity over a single respiratory cycle, divided by the average. Central venous pressure, pulmonary artery occlusion pressure, pulse pressure variation (PPV), and ΔVpeak-CA were recorded before and after volume expansion. RESULTS: PPV and ΔVpeak-CA correlated significantly with an increase in SVI after volume expansion. Area under the receiver-operator characteristic curve (AUROC) of PPV and ΔVpeak-CA were 0.75 [95% confidence interval (CI) 0.59-0.90] and 0.85 (95% CI 0.72-0.97). The optimal cut-off values for fluid responsiveness of PPV and ΔVpeak-CA were 13% (sensitivity and specificity of 0.74 and 0.71) and 11% (sensitivity and specificity of 0.85 and 0.82), respectively. In a subgroup analysis of 17 subjects having pulse pressure hypertension (≥ 60 mm Hg), PPV failed to predict fluid responsiveness (AUROC 0.70, P=0.163), whereas the predictability of ΔVpeak-CA remained unchanged (AUROC 0.90, P=0.006). CONCLUSIONS: Doppler assessment of respirophasic ΔVpeak-CA seems to be a highly feasible and reliable method to predict fluid responsiveness in mechanically ventilated patients undergoing coronary revascularization. CLINICAL TRIAL REGISTRATION: NCT 01836081.
BACKGROUND: We studied respirophasic variation in carotid artery blood flow peak velocity (ΔVpeak-CA) measured by pulsed wave Doppler ultrasound as a predictor of fluid responsiveness in mechanically ventilated patients with coronary artery disease. METHODS: Forty patients undergoing elective coronary artery bypass surgery were enrolled. Subjects were classified as responders if stroke volume index (SVI) increased ≥15% after volume expansion (6 ml kg(-1)). The ΔVpeak-CA was calculated as the difference between the maximum and minimum values of peak velocity over a single respiratory cycle, divided by the average. Central venous pressure, pulmonary artery occlusion pressure, pulse pressure variation (PPV), and ΔVpeak-CA were recorded before and after volume expansion. RESULTS: PPV and ΔVpeak-CA correlated significantly with an increase in SVI after volume expansion. Area under the receiver-operator characteristic curve (AUROC) of PPV and ΔVpeak-CA were 0.75 [95% confidence interval (CI) 0.59-0.90] and 0.85 (95% CI 0.72-0.97). The optimal cut-off values for fluid responsiveness of PPV and ΔVpeak-CA were 13% (sensitivity and specificity of 0.74 and 0.71) and 11% (sensitivity and specificity of 0.85 and 0.82), respectively. In a subgroup analysis of 17 subjects having pulse pressure hypertension (≥ 60 mm Hg), PPV failed to predict fluid responsiveness (AUROC 0.70, P=0.163), whereas the predictability of ΔVpeak-CA remained unchanged (AUROC 0.90, P=0.006). CONCLUSIONS: Doppler assessment of respirophasic ΔVpeak-CA seems to be a highly feasible and reliable method to predict fluid responsiveness in mechanically ventilated patients undergoing coronary revascularization. CLINICAL TRIAL REGISTRATION: NCT 01836081.
Authors: Su Hyun Lee; Yong-Min Chun; Young Jun Oh; Seokyung Shin; Sang Jun Park; Soo Young Kim; Yong Seon Choi Journal: J Clin Monit Comput Date: 2015-12-31 Impact factor: 2.502
Authors: Miguel Á Ibarra-Estrada; José A López-Pulgarín; Julio C Mijangos-Méndez; José L Díaz-Gómez; Guadalupe Aguirre-Avalos Journal: Crit Ultrasound J Date: 2015-06-26