Sanfilippo Filippo, Santonocito Cristina, Zawadka Mateusz, Caruso Alessandro, Bonelli Giovanna, Dugar Siddharth, Vignon Philippe, Noto Alberto
Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Site "Policlinico G. Rodolico", Via S. Sofia N 78, 95123, Catania, Italy.
Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland.
J Ultrasound. 2025 Sep 18. doi: 10.1007/s40477-025-01074-z.
Evaluating fluid responsiveness (FR) is crucial in managing critically ill patients. Measurement of respiratory variations of blood flow (V) is physiologically sound, but blood flow sampling through the aortic valve (AV-V) is not always feasible. We assessed the feasibility of suprasternal V (SS-V), at ascending or descending aorta level, as alternative to AV-V.
Observational prospective study in spontaneously breathing healthy volunteers. We report the overall feasibility of AV- and SS-V, and calculated their interchangeability, the mean bias with limits of agreement (LoA) and percentage error (PE). We defined FR as a 10% increase in cardiac output measured non-invasively with finger-cuff method after passive leg raising.
We enrolled 67 volunteers; SS-V was feasible in 65 volunteers (97%), with sampling in the ascending and descending aorta in 22/65 (33.8%) and 43/65 (66.2%) volunteers, respectively. AV-V was feasible in 64 volunteers (95.5%). When both V were obtained (n = 62), interchangeability using a 12% cut-off was 67.7% (poor agreement with kappa coefficient 0.19 [-0.02;0.41]). Clinical concordance at ascending aorta level was non-significantly higher (16/22, 73% vs 26/40, 65%; p = 0.583). Prediction of FR with SS-V using the 12% cut-off was poor: sensitivity 85%; specificity 9%; positive predictive value 82%; negative predictive value 11%. Bland-Altman's analysis revealed a mean bias -2.6% [-4.3%;-1.0%] with LoA ranging from -15.2% [- 18.1%;- 12.4%] to 10.0% [7.2%;12.8%]. The mean PE was 7.87%.
We report excellent feasibility for SS-V, though with moderate interchangeability and accuracy; however, we found poor precision and poor performances in predicting FR in healthy volunteers.
评估液体反应性（FR）对于危重症患者的管理至关重要。测量血流的呼吸变化（V）在生理上是合理的，但通过主动脉瓣（AV-V）进行血流采样并不总是可行的。我们评估了在升主动脉或降主动脉水平的胸骨上V（SS-V）作为AV-V替代方法的可行性。
对自主呼吸的健康志愿者进行观察性前瞻性研究。我们报告了AV-V和SS-V的总体可行性，并计算了它们的互换性、带有一致性界限（LoA）的平均偏差和百分比误差（PE）。我们将FR定义为被动抬腿后用指套法无创测量的心输出量增加10%。
我们招募了67名志愿者；65名志愿者（97%）的SS-V可行，分别有22/65（33.8%）和43/65（66.2%）的志愿者在升主动脉和降主动脉进行采样。64名志愿者（95.5%）的AV-V可行。当同时获得两种V时（n = 62），使用12%的截断值时互换性为67.7%（与kappa系数0.19 [-0.02; = 0.41]的一致性较差）。升主动脉水平的临床一致性略高但无统计学意义（16/22，73%对26/40，65%；p = 0.583）。使用12%截断值的SS-V对FR的预测较差：敏感性85%；特异性9%；阳性预测值82%；阴性预测值11%。Bland-Altman分析显示平均偏差为-2.6% [-4.3%; -1.0%]，LoA范围为-15.2% [-18.1%; -12.4%]至10.0% [7.2%; 12.8%]。平均PE为7.87%。
我们报告了SS-V具有出色的可行性，尽管互换性和准确性中等；然而，我们发现其在预测健康志愿者的FR方面精度较差且表现不佳。
