Srivastava Ankur, Tam Christopher, Sethi Samir, Gaudino Mario, Rippon Brady, Baidya Joydeep, Rastogi Sanya, Lopes Alexandra, Kasubhai Avika, Pryor Kane, Osorio James
Department of Anesthesiology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY 10065, USA.
Department of Anesthesiology, Montefiore Medical Center, Bronx, NY 10467, USA.
J Clin Med. 2025 Sep 22;14(18):6657. doi: 10.3390/jcm14186657.
Identifying fluid-responsive patients is essential in managing hemodynamic instability. Traditional static measures like central venous pressure (CVP) are often unreliable. Prior studies suggest that cardiac ultrasound (US), particularly carotid Doppler point-of-care ultrasound (POCUS), may correlate with pulmonary artery catheter (PAC)-derived cardiac output (CO), offering a noninvasive tool to assess fluid responsiveness. We aimed to evaluate the correlation between carotid ultrasound (US) parameters and pulmonary artery catheter (PAC) derived measurements in post cardiac surgery patients. We conducted a prospective cohort study on 50 postcardiac surgery patients from 2019 to 2022 in a single cardiothoracic ICU. Carotid US and PAC CO measurements were obtained at four intervals: pre- and post-passive leg raise (fluid challenge) on ICU admission, and one hour later. Fluid responsiveness was defined as a ≥10% increase in carotid blood flow, ≥7 ms increase in corrected flow time (FTc), or ≥10% change in respiratory peak carotid systolic velocity (ΔCDPV). Pearson's correlation and linear regression were used to assess associations between carotid US and PAC changes. Agreement in fluid responsiveness categorization (≥10% CO change) was evaluated using weighted Cohen's kappa. Significance was set at α = 0.05. No significant correlation was found between changes in carotid US parameters and the PAC cardiac index (CI) at baseline or one hour for ΔCDPV, FTc, or carotid blood flow. A moderate correlation was observed between carotid blood flow and FTc at one hour (r = 0.41, = 0.005). Regression and sensitivity analyses showed no significant associations. The carotid US parameters did not correlate with PAC-derived CO after passive leg raise. Further studies are needed to validate carotid POCUS in this setting.
识别液体反应性患者对于处理血流动力学不稳定至关重要。传统的静态指标如中心静脉压（CVP）往往不可靠。先前的研究表明，心脏超声（US），尤其是颈动脉多普勒床旁超声（POCUS），可能与肺动脉导管（PAC）测得的心输出量（CO）相关，从而提供一种非侵入性工具来评估液体反应性。我们旨在评估心脏手术后患者颈动脉超声（US）参数与肺动脉导管（PAC）测得的指标之间的相关性。我们于2019年至2022年在一家心胸重症监护病房对50例心脏手术后患者进行了一项前瞻性队列研究。在四个时间点获取颈动脉超声和PAC CO测量值：入住重症监护病房时被动抬腿（液体冲击）前后，以及一小时后。液体反应性定义为颈动脉血流增加≥10%、校正血流时间（FTc）增加≥7毫秒或呼吸峰值颈动脉收缩速度变化（ΔCDPV）≥10%。采用Pearson相关性分析和线性回归来评估颈动脉超声与PAC变化之间的关联。使用加权Cohen's kappa评估液体反应性分类（CO变化≥10%）的一致性。显著性设定为α = 0.05。在基线或一小时时，对于ΔCDPV、FTc或颈动脉血流，未发现颈动脉超声参数变化与PAC心脏指数（CI）之间存在显著相关性。在一小时时观察到颈动脉血流与FTc之间存在中度相关性（r = 0.41，P = 0.005）。回归分析和敏感性分析均未显示出显著关联。被动抬腿后，颈动脉超声参数与PAC测得的CO不相关。需要进一步研究以验证在此情况下颈动脉POCUS的有效性。
