Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
5651089 | The American Journal of Emergency Medicine | 2017 | 4 Pages |
ObjectiveTo evaluate respiratory variations in carotid and brachial peak velocity and other hemodynamic parameters to predict responsiveness to fluid challenge.MethodsA prospective observational study was performed on mechanically ventilated patients with septic shock. Outcomes included the measurements of central venous pressure, intrathoracic blood volume index, stroke volume variation (SVV), pleth variability index(PVI), and ultrasound assessments of respiratory variations in inferior vena cava diameter (ÎIVC), carotid Doppler peak velocity (ÎCDPV), and brachial artery peak velocity (ÎVpeak brach).ResultsAll patients received 200 mL normal saline challenge. There were 27 responders and 22 non-responders. Responders had higher SVV, PVI, ÎIVC, ÎCDPV, and ÎVpeak brach measurements. In addition, all these measurements had statistically significant linear correlations with changes in cardiac index (CI).When responders were defined by ÎCI â¥Â 10%, receiver operating characteristics (ROC) curve analysis showed that fluid responsiveness could be predicted:11.5% optimal cut-off 1evels of SVV with sensitivity of 75% and specificity of 85%, 15.5% optimal cut-off 1evels of PVI with sensitivity of 65% and specificity of 80%, 20.5% optimal cut-off 1evels of ÎIVC with sensitivity of 67% and specificity of 77%, 13% optimal cut-off 1evels of ÎCDPV with sensitivity of 78%% and specificity of 90%, 11.7% optimal cut-off 1evels of ÎVpeak brach with sensitivity of 70% and specificity of 80%.ConclusionUltrasound assessment of ÎIVC and ÎVpeak brach, especially ÎCDPV, could predict fluid responsiveness and might be recommended as a continuous and noninvasive method to monitor functional hemodynamic parameter in mechanically ventilated patients with septic shock.