Carotid doppler indices do not predict fluid responsiveness in mechanically ventilated patients undergoing coronary artery bypass grafting surgery. Issue 12 (17th October 2022)

• Record Type: Journal Article
• Authors: Khan, Saba; Mishra, Sandeep Kumar; Parida, Satyen; Jha, Ajay Kumar; Nagabhushanam Padala, Sri Rama Ananta
• Is Part Of: Journal of cardiac surgery. Volume 37:Issue 12(2022)
• Page Start: 4418
• Page End: 4424
• Publication Date: 2022-10-17
• Subjects: carotid blood flow -- carotid flow time -- fluid responsiveness -- peak systolic velocity -- preload responsiveness -- respiratory variation; Heart -- Surgery -- Periodicals; 617.412005
• DOI: 10.1111/jocs.17035
• Languages: English
• ISSNs: 0886-0440

Abstract

Abstract: Background and Aim of the Study: This study aimed to determine the predictive value of carotid artery blood flow (CABF), corrected carotid flow time (CFT), and respiratory variation in carotid peak systolic velocity (DVPeakCA) for fluid responsiveness in mechanically ventilated patients undergoing coronary artery bypass grafting (CABG) surgery. It also aimed to correlate each of these indices with changes in stroke volume index (SVI) after a fluid bolus. Methods: This prospective, interventional, before–after study recruited 45 adult patients undergoing CABG. Following induction of anesthesia, a fluid challenge of 6 ml/kg of a crystalloid solution was delivered over 10 min. Mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), CABF, CFT, and DVPeakCA were recorded before and following the intervention. Patients with an increase in SVI of >15% from baseline were considered responders. Results: We had 22 responders and 23 nonresponders. Areas under the receiver operating characteristic (AUROC) curves for the studied indices (CABF, 0.516, CFT, 0.502, and DVPeakCA, 0.671) did not suggest any strong predictive value to detect fluid responsiveness. Similarly, the r values for correlation of these carotid doppler‐derived indices, both baseline and as % change from baseline with the % alteration of SVI were all <0.2, which demonstrates a very weak correlation between these variables. Conclusions: Carotid doppler indices are unreliable to assess fluid responsiveness, and cannot replace invasive methods of analyzing preload optimization. There was no significant correlation between carotid doppler‐derived indices and alterations in SVI before and after the fluid bolus.