Critical Care: Imaging in Critical Illness |

Carotid Artery Flow Time Corrected (FTc) Changes Induced by Passive Leg Raise (PLR) Can Predict Fluid Responsiveness in Mechanically Ventilated (MV) Patients FREE TO VIEW

Alai Taggu, DM; Nui Darang; Shashidhar Patil
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St. John's Medical College Hospital, Bangalore, India

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):294A. doi:10.1016/j.chest.2016.08.307
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SESSION TITLE: Imaging in Critical Illness

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 25, 2016 at 11:00 AM - 12:15 PM

PURPOSE: INTRODUCTION:Fluid administration is aimed at increasing the stroke volume. Assessment of preload responsiveness is difficult. Access to carotid artery is easy and practical for bedside use. OBJECTIVE : To test the hypothesis that Carotid artery flow time changes induced by PLR can predict volume responsiveness in MV patients.

METHODS: A prospective observation study conducted in MV patients admitted in a mixed ICU between 1st May 2012 to 31st July 2013.All adult patients considered eligible for fluid resuscitation as decided by the attending physician were included. Exclusion criteria: Pregnant patients, head injury , intra-abdominal hypertension , amputees, those with incomplete records were excluded. PROTOCOL: Linear transducer with pulse wave doppler was used on common carotid artery for recording carotid artery FTc. A 4F thermistor-tipped arterial catheter (Pulsiocath thermodilution catheter; Pulsion Medical Systems, Germany) was inserted in the femoral artery, which was connected to the PiCCO (Pulsion Medical Systems, Germany) and the bedside monitor (IntelliVue MP50/70: Philips Medical System, Germany). Hemodynamic indices were determined using a triplicate injection of 15 mL ice-cold normal saline within 5 minutes through an additional 7 F central venous catheter introduced in the right internal jugular vein. The bolus thermodilution measurements were made by the same observer to avoid interobserver variation . All recordings taken at baseline in semi-recumbent positions. Patients were put supine and after 5 minutes, PLR was done. The maximum SV during the PLR was recorded. Carotid FTc was measured at 1, 2 and 3 minutes. Maximum carotid FTc value was considered. Fluid responsiveness was defined as >15% in SV after volume expansion (VE).

RESULTS: Total of 196 patients were enrolled for the study. Mean age was 52 .5(sD10.3 )years; Male:Female 107:89, BMI (kg/m2) 21.4 (sd 5.2), mean APACHE II score 21 (sD 5.6) with mean mechanical ventilation days of 15.4 (sD 9.4) and mean ICU days of 17.6 (sD 10.3). Disease types : 54.6% Respiratory, 13.7% surgical, 10.5% Acute febrile illness, 7.50% CNS and 13.7% were others. Fluid responsiveness were seen in 49.8% with changes in stroke volume >15% after VE. Change in Carotid FTc of 22.6% in response to PLR to predicted volume responsiveness-Sensitivity was 76.5%, Specificity 88.7% and ROC Curve of 0.872 (95% CI 0.56- 1.0).

CONCLUSIONS: The Carotid FTc increase of 22.6% during PLR is a reliable predictor of fluid responsiveness in MV patients.

CLINICAL IMPLICATIONS: Ultrasound has become a point of care tool. Use of carotid artery flow time doppler needs very minimal training and hence can be reliably used bedside for fluid responsiveness .

DISCLOSURE: The following authors have nothing to disclose: Alai Taggu, Nui Darang, Shashidhar Patil

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