Carotid artery velocity time integral and corrected flow time measured by a wearable Doppler ultrasound detect stroke volume rise from simulated hemorrhage to transfusion

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Abstract

Objective

Doppler ultrasonography of the common carotid artery is used to infer stroke volume change and a wearable Doppler ultrasound has been designed to improve this workflow. Previously, in a human model of hemorrhage and resuscitation comprising approximately 50,000 cardiac cycles, we found a strong, linear correlation between changing stroke volume, and measures from the carotid Doppler signal, however, optimal Doppler thresholds for detecting a 10% stroke volume change were not reported. In this Research Note, we present these thresholds, their sensitivities, specificities and areas under their receiver operator curves (AUROC).

Results

Augmentation of carotid artery maximum velocity time integral and corrected flowtime by 18% and 4%, respectively, accurately captured 10% stroke volume rise. The sensitivity and specificity for these thresholds were identical at 89% and 100%. These data are similar to previous investigations in healthy volunteers monitored by the wearable ultrasound.

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Most cited references 21

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Plasma Hsp90 levels in patients with systemic sclerosis and relation to lung and skin involvement: a cross-sectional and longitudinal study

Hana Storkanova, Sabina Oreska, Maja Spiritovic … (2021)

Our previous study demonstrated increased expression of Heat shock protein (Hsp) 90 in the skin of patients with systemic sclerosis (SSc). We aimed to evaluate plasma Hsp90 in SSc and characterize its association with SSc-related features. Ninety-two SSc patients and 92 age-/sex-matched healthy controls were recruited for the cross-sectional analysis. The longitudinal analysis comprised 30 patients with SSc associated interstitial lung disease (ILD) routinely treated with cyclophosphamide. Hsp90 was increased in SSc compared to healthy controls. Hsp90 correlated positively with C-reactive protein and negatively with pulmonary function tests: forced vital capacity and diffusing capacity for carbon monoxide (DLCO). In patients with diffuse cutaneous (dc) SSc, Hsp90 positively correlated with the modified Rodnan skin score. In SSc-ILD patients treated with cyclophosphamide, no differences in Hsp90 were found between baseline and after 1, 6, or 12 months of therapy. However, baseline Hsp90 predicts the 12-month change in DLCO. This study shows that Hsp90 plasma levels are increased in SSc patients compared to age-/sex-matched healthy controls. Elevated Hsp90 in SSc is associated with increased inflammatory activity, worse lung functions, and in dcSSc, with the extent of skin involvement. Baseline plasma Hsp90 predicts the 12-month change in DLCO in SSc-ILD patients treated with cyclophosphamide.

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The use of bioreactance and carotid Doppler to determine volume responsiveness and blood flow redistribution following passive leg raising in hemodynamically unstable patients.

Alex Levitov, Paul E Marik, Penny L Andrews … (2013)

The clinical assessment of intravascular volume status and volume responsiveness is one of the most difficult tasks in critical care medicine. Furthermore, accumulating evidence suggests that both inadequate and overzealous fluid resuscitation are associated with poor outcomes. The objective of this study was to determine the predictive value of passive leg raising (PLR)- induced changes in stroke volume index (SVI) as assessed by bioreactance in predicting volume responsiveness in a heterogenous group of patients in the ICU. A secondary end point was to evaluate the change in carotid Doppler fl ow following the PLR maneuver. During an 8-month period, we collected clinical, hemodynamic, and carotid Doppler data on hemodynamically unstable patients in the ICU who underwent a PLR maneuver as part of our resuscitation protocol. A patient whose SVI increased by . 10% following a fluid challenge was considered a fluid responder. A complete data set was available for 34 patients. Twenty-two patients (65%) had severe sepsis/septic shock, whereas 21 (62%) required vasopressor support and 19 (56%) required mechanical ventilation. Eighteen patients (53%) were volume responders. The PLR maneuver had a sensitivity of 94% and a specificity of 100% for predicting volume responsiveness (one false negative result). In the 19 patients undergoing mechanical ventilation, the stroke volume variation was 18.0% 5.1% in the responders and 14.8% 3.4% in the nonresponders ( P 5 .15). Carotid blood fl ow increased by 79% 32% after the PLR in the responders compared with 0.1% 14% in the nonresponders ( P , .0001). There was a strong correlation between the percent change in SVI by PLR and the concomitant percent change in carotid blood fl ow ( r 5 0.59, P 5 .0003). Using a threshold increase in carotid Doppler fl ow imaging of 20% for predicting volume responsiveness, there were two false positive results and one false negative result, giving a sensitivity and specificity of 94% and 86%, respectively. We noted a significant increase in the diameter of the common carotid artery in the fluid responders. Monitoring the hemodynamic response to a PLR maneuver using bioreactance provides an accurate method of assessing volume responsiveness in critically ill patients. In addition, the study suggests that changes in carotid blood fl ow following a PLR maneuver may be a useful adjunctive method for determining fluid responsiveness in hemodynamically unstable patients.

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The accuracy of noninvasive cardiac output and pressure measurements with finger cuff: a concise review.

Koen Ameloot, Pieter-Jan Palmers, Manu Malbrain (2015)

The present review aims to summarize literature on the accuracy of the finger cuff method to measure cardiac output (CO) and blood pressure, its ability to track hemodynamic changes, and to predict fluid responsiveness.

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Author and article information

Contributors

Jon-Émile S. Kenny:

ORCID: http://orcid.org/0000-0002-3654-1146

jon-emile@heart-lung.org

Journal

Journal ID (nlm-ta): BMC Res Notes

Journal ID (iso-abbrev): BMC Res Notes

Title: BMC Research Notes

Publisher: BioMed Central (London )

ISSN (Electronic): 1756-0500

Publication date (Electronic): 10 January 2022

Publication date PMC-release: 10 January 2022

Publication date Collection: 2022

Volume: 15

Electronic Location Identifier: 7

Affiliations

[1 ]GRID grid.420638.b, ISNI 0000 0000 9741 4533, Health Sciences North Research Institute, ; 56 Walford Rd, Sudbury, ON P3E 2H2 Canada

[2 ]Flosonics Medical, 325 Front Street, Toronto, ON M5V 2Y1 Canada

[3 ]GRID grid.19006.3e, ISNI 0000 0000 9632 6718, Division of Pulmonary and Critical Care, Department of Medicine, , David Geffen School of Medicine at UCLA, ; Los Angeles, CA USA

[4 ]GRID grid.240160.1, ISNI 0000 0004 0633 8600, Department of Emergency Medicine, , Maine Medical Center, ; Portland, ME USA

[5 ]GRID grid.67033.31, ISNI 0000 0000 8934 4045, Tufts University School of Medicine, ; Boston, MA USA

[6 ]GRID grid.436533.4, ISNI 0000 0000 8658 0974, Northern Ontario School of Medicine, ; Sudbury, ON Canada

[7 ]GRID grid.66875.3a, ISNI 0000 0004 0459 167X, Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, , Mayo Clinic, ; Rochester, MN USA

Author information

Jon-Émile S. Kenny http://orcid.org/0000-0002-3654-1146

Article

Publisher ID: 5896

DOI: 10.1186/s13104-021-05896-y

PMC ID: 8750810

PubMed ID: 35012624

SO-VID: a4522b24-f10a-4550-a1f0-a5384d3adaea

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 12 August 2021

Date accepted : 21 December 2021

Funding

Funded by: Office of the Under Secretary of Defense for Health Affairs

Award ID: W81XWH1910591

Award Recipient : Jon-Émile S. Kenny

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ScienceOpen disciplines: Medicine

Keywords: carotid doppler,stroke volume,velocity time integral,corrected flow time

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ScienceOpen disciplines: Medicine

Keywords: carotid doppler, stroke volume, velocity time integral, corrected flow time

Carotid artery velocity time integral and corrected flow time measured by a wearable Doppler ultrasound detect stroke volume rise from simulated hemorrhage to transfusion

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Stroke MRI

Most cited references 21

Plasma Hsp90 levels in patients with systemic sclerosis and relation to lung and skin involvement: a cross-sectional and longitudinal study

The use of bioreactance and carotid Doppler to determine volume responsiveness and blood flow redistribution following passive leg raising in hemodynamically unstable patients.

The accuracy of noninvasive cardiac output and pressure measurements with finger cuff: a concise review.

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