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Objective:To investigate the value of monitor carotid velocity time integral (VTI) and corrected flow time (FTc) by bedside ultrasound before and after passive leg raising (PLR) in predicting fluid responsiveness in critically ill patients.Methods:A prospective observational study was conducted. Fifty patients with critical illness admitted to the First People's Hospital of Fuyang Hangzhou from January 2020 to March 2021 were enrolled. The clinical data including the gender, age, body mass index (BMI), acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, and the duration of mechanical ventilation were recorded. The changes of carotid VTI and FTc were measured by bedside ultrasound, and the values of heart rate, mean arterial pressure (MAP), central venous pressure (CVP), stroke volume index (SVI), and intrathoracic blood volume index (ITBVI) were measured by pulse indicated continuous cardiac output (PiCCO) monitor before and after PLR in all patients. According to the changes of SVI before and after PLR, the patients were divided into fluid responsiveness positive group with the change rate of SVI≥15% and fluid responsiveness negative group with the change rate of SVI < 15%. The differences in the values of VTI, FTc, CVP, and ITBVI obtained before and after PLR (ΔVTI, ΔFTc, ΔCVP and ΔITBVI) were calculated and then compared between the two groups. The predictive values of these indicators on fluid responsiveness in critically ill patients were analyzed by receiver operator characteristic curve (ROC curve), and their relationship with the difference in SVI (ΔSVI) obtained before and after PLR was evaluated by Pearson correlation analysis.Results:Fifty patients were all enrolled in this study, in which 27 patients were fluid response and 23 patients were fluid nonresponse. Basic clinical data were not different between the two groups. The values of ΔVTI, ΔFTc, ΔCVP, and ΔITBVI in fluid response were all significantly higher than those in fluid nonresponse [ΔVTI (cm): 2.07±1.16 vs. 0.67±0.86, ΔFTc (ms): 4.00±6.10 vs. 0.01±2.26, ΔCVP (cmH 2O, 1 cmH 2O = 0.098 kPa): 1.67±1.14 vs. 1.00±1.17, ΔITBVI (mL/m 2): 98±69 vs. 48±70, all P < 0.05]. ROC curve analysis showed that ΔVTI, ΔFTc, ΔCVP and ΔITBVI were all positive for predicting fluid responsiveness, their area under ROC curve (AUC) and 95% confidence interval (95% CI) were 0.870 (0.769-0.972), 0.694 (0.547-0.841), 0.684 (0.535-0.832) and 0.709 (0.564-0.855), respectively. When using ΔVTI 0.92 cm, ΔFTc 1.45 ms, ΔCVP 1.50 cmH 2O and ΔITBVI 44.50 mL/m 2 as the threshold values, the sensitivities were 96.3%, 63.0%, 44.4% and 81.5%, and the specificities were 65.2%, 78.3%, 82.6% and 56.5%, respectively, in which the predictive value of ΔVTI was the largest. Pearson correlation analysis indicated that ΔVTI, ΔFTc, ΔCVP, and ΔITBVI were positively associated with ΔSVI ( r values were 0.971, 0.334, 0.440, 0.650, P values were 0.000, 0.018, 0.001, 0.000, respectively). Conclusion:Carotid ΔVTI and ΔFTc monitored by bedside ultrasound before and after PLR could be as effective as conventional indicators in predicting fluid responsiveness in critically ill patients, and the predictive value of ΔVTI was better than others.
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Objective To evaluate the ability of pleth variability index(PVI) for predicting volume responsiveness after general anesthesia induction intubation in the patients undergoing intestinal tract surgery with the velocity-time integral(VTI) of left ventricular outflow tract blood monitored by transthoracic echocardiography as the standard.Methods Twenty-five patients undergoing intestinal tract surgery were selected.After general anesthesia induction,7 mL/kg colloidal solution was infused before operation beginning,if the VTI increased percentage(△VTI％)≥10 ％,200 mL colloidal solution was infused by 50mL syringe until △VTI％＜10％;the hemodynamic indicators of MAP,CVP,HR,PI VTI and PVI were recorded before and after infusion solution.Results The PVI basic value in the patients with response was significantly higher than that in the patients without response(P＜0.05);the Pearson correlation analysis found that there was a significant linear correlation between PVI basic value and △VTI％ before infusion solution(P＜0.05);the optimal diagnostic threshold value of PVI was 13.51,its sensitivity for monitoring the volume responsiveness was 69.25％ and specificity was 70.00％.The area under the receiver operating characteristic(ROC) curve(AUC) was 0.75(95％ CI:0.63-0.88,P＜0.01).Conclusion PVI can predict the volume responsiveness in the patients undergoing intestinal tract surgery.The PVI value ＞13.51 indicates that the patient may be in hypovolemia status and needs the volume therapy.
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Objective To investigate the use of PLR induced VTI changes combined with P(cv-a)CO2 in sepsis shock early fluid resuscitation. Methods 54 patients with sepsis shock admitted in Chancheng district central hospital from March 2016 to May 2017 were randomly divided into the treatment group (n=26) and the control group (n=28). The treatment group were monitored by the PLR induced VTI changes combined with P(cv-a)CO2, while the control group were monitored by CVP. The changes of 6 h, 12 h, 24 h, CVP, BNP and LAC levels, the time of vasoactive drugs, the time of mechanical ventilation, ICU hospitalization time and mortality were compared between the two groups. Results There were no statistic difference in fluid infusion within 6h, CVP, BNP, and LAC levels in the two groups; Fluid infusion within 12 h and 24 h, CVP and BNP in the treatment group were lower than those in the control group (P<0.05); the two groups for the treatment of 12 h,24 h plasma, LAC levels were no significant difference; The application time of vasoactive drugs, the time of mechanical ventilation and the length of hospitalization in ICU in the treatment group were shorter than those in the control group (P<0.05); The 28 day mortality was not statistically different between the two groups. Conclusion PLR induced VTI changes combined with P (cv-a) CO2 in septic shock early fluid resuscitation monitoring is superior to CVP, which has the important research significance.
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Aims and Objectives: Physiologically coronary sinus (CS) drains the left coronary artery (LCA) territory. Stenosis of the branches of LCA may decrease the coronary sinus blood flow (CSBF). Any intervention that aims at restoring the flow of the stenosed vessel increases coronary artery flow that should consequently increase the CSBF. Hence, this study was undertaken to assess the CSBF before and after each branch of LCA to determine the adequacy of surgical revascularization in patients undergoing elective off pump coronary artery bypass grafting (OPCAB) using transesophageal echocardiography (TEE). Materials and Methods: Thirty consecutive patients scheduled for elective OPCAB were enrolled. CSBF was assessed before and after each branch of LCA revascularization using TEE. Left internal mammary artery (LIMA) Doppler was also obtained post LIMA to left anterior descending (LAD) grafting. Results: Hemodynamic and echocardiographic variables were compared by means of Student’s t-test for paired data before and after revascularization. The CSBF per beat (1.28 ± 0.71), CSBF per minute (92.59 ± 59.32) and total velocity time integral (VTI) (8.93 ± 4.29) before LAD grafting showed statistically significant increase to CSBF per beat (1.70 ± 0.89), CSBF per minute (130.72 ± 74.22) and total VTI (11.96 ± 5.68) after LAD revascularization. The CSBF per beat (1.67 ± 1.03), CSBF per minute (131.91 ± 86.59) and total VTI (11.00 ± 5.53) before obtuse marginal (OM) grafting showed statistically significant increase to CSBF per beat (1.91 ± 1.03), CSBF per min (155.20 ± 88.70) and total VTI (12.09 ± 5.43) after OM revascularization. In 9 patients, color flow Doppler of LIMA could be demonstrated which showed diastolic predominant blood flow after LIMA to LAD grafting. Conclusion: Demonstration of CSBF was simple and monitoring the trend of CSBF values before and after each graft of LCA territory will guide to determine the adequacy of surgical revascularization.
Subject(s)
Blood Flow Velocity/analysis , Blood Flow Velocity/physiology , Coronary Artery Bypass, Off-Pump/methods , Coronary Artery Disease/surgery , Coronary Circulation , Echocardiography, Transesophageal/methods , Humans , Mammary Arteries/physiology , Myocardial Revascularization/methodsABSTRACT
The purpose of this study is to evaluate pulsed Doppler echocardiographic method (PD) for the measurement of pulmonary to systemic flow ratio (QP/Qs) and pulmonary arterial pressure in children. We studied 32 children with left to right shunt who had undergone cardiac catheterization, 11 children who had heart diseases without shunt and 14 normal children. Velocity time intergral (VTI) was calculated by triangulated meansurement [1/2(maximum blood velocityxejection time)]. Doppler blood flow was calculated from the equation : Doppler blood flow=VTIxcross sectional areaxheart rate. The following Doppler time intervals and ratio of intervals were also measured : preejection period(PEP), acceleration time(AT), ejection time (ET), PEP/AT, PEP/ET and AT/ET. Qp/Qs measured by PD was 1.09+/-0.15 (mean+/-SD) in children with no shunt and normal children. A high correlation was found between Fick and Doppler-derived Qp/Qs in children with left to right shunt (r=0.87). All the children with Qp/Qs less than 1.5 showed no significant discrepancy between two methods. The best correlation with pulmonary arterial pressure was achieved by the PEP/AT (r=0.84 vs systolic pressure). Sensitivity and specificity of PEP/AT for predicting pulmonary arterial hypertension were 79% and 95%, respecitively. In conclusion, it is thought that determination of Qp/Qs and prediction of pulmonary arterial pressure in children by PD is a useful, noninvasive method and triangulated measurement may be used as a simple and easy method for the measurement of Qp/Qs.