Judson P Immanuel, Abhilash Kundavaram Paul Prabhakar, Pichamuthu Kishore, Chandy Gina Maryann
Department of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
Department of Critical Care, Christian Medical College, Vellore, Tamil Nadu, India.
J Med Ultrasound. 2020 Oct 1;29(2):99-104. doi: 10.4103/JMU.JMU_77_20. eCollection 2021 Apr-Jun.
Assessing fluid responsiveness in critically ill patients is challenging. Objective, noninvasive tests that are easy to perform are needed. Doppler measurements of dynamic carotid artery parameters such as carotid blood flow (CBF) and carotid flow time (CFT) are being studied as the potential indicators of volume responsiveness, but the data supporting its use are sparse.
This prospective, observational study was conducted in the adult emergency department from June to September 2018. Patients who were prescribed a bolus of 500 ml of crystalloid for any indication were enrolled. Carotid Doppler was performed before and after a fluid bolus to measure the change in CBF and CFT. The aim of our study was to determine if CFT can be used as a marker of fluid responsiveness.
During the 4-month study period, 209 patients were recruited through convenient sampling after obtaining informed written consent. 29.6% of patients presented with a mean arterial pressure (MAP) <65, among whom 58.1% had septic shock. The baseline CBF was 643.0 ± 212.7 ml/min, and it was 583.9 ± 207.1 ml/min and 668 ± 210.8 ml/min in hypotensive and normotensive patients, respectively. Considering a >10% increase in CBF as fluid response, there were 59% responders and 41% nonresponders. The MAP increased by 9.5% in the responders, while there was no significant change in CFT after the fluid bolus. There was no difference in CFT among the responders as compared to the nonresponders. There was no correlation between the change of CBF and CFT ( = 0.013, = 0.061) after the fluid bolus.
Though easy to perform, CFT is probably not a good indicator of fluid responsiveness.
评估危重症患者的液体反应性具有挑战性。需要客观、易于实施的非侵入性检测方法。动态颈动脉参数（如颈动脉血流量（CBF）和颈动脉血流时间（CFT））的多普勒测量正作为容量反应性的潜在指标进行研究，但支持其应用的数据较少。
这项前瞻性观察性研究于2018年6月至9月在成人急诊科进行。纳入因任何适应证接受500ml晶体液推注的患者。在液体推注前后进行颈动脉多普勒检查，以测量CBF和CFT的变化。我们研究的目的是确定CFT是否可作为液体反应性的标志物。
在4个月的研究期间，通过便利抽样在获得知情书面同意后招募了209例患者。29.6%的患者平均动脉压（MAP）<65，其中58.1%患有感染性休克。基线CBF为643.0±212.7ml/min，低血压和血压正常的患者分别为583.9±207.1ml/min和668±210.8ml/min。将CBF增加>10%视为液体反应，有59%的反应者和41%的无反应者。反应者的MAP增加了9.5%，而液体推注后CFT无显著变化。反应者与无反应者之间的CFT无差异。液体推注后CBF和CFT的变化之间无相关性（r = 0.013，p = 0.061）。
尽管易于实施，但CFT可能不是液体反应性的良好指标。
