Respiratory Variation in Carotid Artery Peak Systolic Velocity Is Unable to Predict Fluid Responsiveness in Spontaneously Breathing Critically Ill Patients When Assessed by Novice Physician Sonologists

Author:

Abbasi Adeel1ORCID,Nayeemuddin Mohammed1,Azab Nader1,Schick Alexandra2,Lopardo Thomas3,Phillips Gary S.4,Merchant Roland C.56,Levy Mitchell M.1,Blaivas Michael7,Corl Keith A.1ORCID

Affiliation:

1. Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Warren Alpert School of Medicine at Brown University, Providence, RI, USA

2. Department of Emergency Medicine, Warren Alpert School of Medicine at Brown University, Providence, RI, USA

3. Warren Alpert School of Medicine at Brown University, Providence, RI, USA

4. Department of Biomedical Informatics, Center for Biostatistics, Ohio State University, Columbus, OH, USA

5. Brown University School of Public Health, Providence, RI, USA

6. Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

7. Department of Emergency Medicine, University of South Carolina School of Medicine, St Francis Hospital, Columbus, GA, USA

Abstract

Background: Respiratory variation in carotid artery peak systolic velocity (ΔVpeak) assessed by point-of-care ultrasound (POCUS) has been proposed as a noninvasive means to predict fluid responsiveness. We aimed to evaluate the ability of carotid ΔVpeak as assessed by novice physician sonologists to predict fluid responsiveness. Methods: This study was conducted in 2 intensive care units. Spontaneously breathing, nonintubated patients with signs of volume depletion were included. Patients with atrial fibrillation/flutter, cardiogenic, obstructive or neurogenic shock, or those for whom further intravenous (IV) fluid administration would be harmful were excluded. Three novice physician sonologists were trained in POCUS assessment of carotid ΔVpeak. They assessed the carotid ΔVpeak in study participants prior to the administration of a 500 mL IV fluid bolus. Fluid responsiveness was defined as a ≥10% increase in cardiac index as measured using bioreactance. Results: Eighty-six participants were enrolled, 50 (58.1%) were fluid responders. Carotid ΔVpeak performed poorly at predicting fluid responsiveness. Test characteristics for the optimum carotid ΔVpeak of 8.0% were: area under the receiver operating curve = 0.61 (95% CI: 0.48-0.73), sensitivity = 72.0% (95% CI: 58.3-82.56), specificity = 50.0% (95% CI: 34.5-65.5). Conclusions: Novice physician sonologists using POCUS are unable to predict fluid responsiveness using carotid ΔVpeak. Until further research identifies key limiting factors, clinicians should use caution directing IV fluid resuscitation using carotid ΔVpeak.

Funder

National Institutes of Health

Publisher

SAGE Publications

Subject

Critical Care and Intensive Care Medicine

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