ABSTRACT
PURPOSE: We sought to assess whether ultrasound (US) measurements of carotid flow time (CFTc) and carotid blood flow (CBF) predict fluid responsiveness in patients with suspected sepsis. METHODS: This was a prospective observational study of hypotensive (systolic blood pressureâ<â90) patients "at risk" for sepsis receiving intravenous fluids (IVF) in the emergency department. US measurements of CFTc and CBF were performed at time zero and upon completion of IVF. All US measurements were repeated after a passive leg raise (PLR) maneuver. Fluid responsiveness was defined as normalization of blood pressure without persistent hypotension or need for vasopressors. RESULTS: A convenience sample of 69 patients was enrolled. The mean age was 65; 49% were female. Fluid responders comprised 52% of the cohort. CFTc values increased significantly with both PLR (Pâ=â0.047) and IVF administration (Pâ=â0.003), but CBF values did not (Pâ=â0.924 and Pâ=â0.064 respectively). Neither absolute CFTc or CBF measures, nor changes in these values with PLR or IVF bolus, predicted fluid responsiveness, mortality, or the need for intensive care unit admission. CONCLUSION: In patients with suspected sepsis, a fluid challenge resulted in a significant change in CFTc, but not CBF. Neither absolute measurement nor delta measurements with fluid challenge predicted clinical outcomes.
Subject(s)
Carotid Arteries/diagnostic imaging , Fluid Therapy , Hypotension/diagnostic imaging , Hypotension/therapy , Sepsis/diagnostic imaging , Ultrasonography , Aged , Aged, 80 and over , Blood Flow Velocity , Carotid Arteries/physiopathology , Cross-Sectional Studies , Female , Humans , Hypotension/complications , Male , Middle Aged , Prospective Studies , Regional Blood Flow/physiology , Sepsis/complications , Sepsis/therapy , Treatment OutcomeABSTRACT
Pulsus paradoxus (PP) is defined as a fall of systolic blood pressure of greater than 10 mm Hg during the inspiratory phase of respiration. Measurement of PP is recommended by national and international asthma guidelines as an objective measure of asthma severity but is rarely used in clinical practice. Cardiac point-of-care ultrasound with pulsed wave Doppler imaging measuring respiratory-phasic changes of mitral valve inflow velocities is well described in cardiac tamponade as "sonographic" PP. We present 10 cases of acute asthma presenting to an emergency department showing the finding of sonographic determined PP in the apical 4-chamber view of the heart on pulsed wave Doppler imaging.
