Correlation between Carotid and Brachial Artery Velocity Time Integral and Their Comparison to Pulse Pressure Variation and Stroke Volume Variation for Assessing Fluid Responsiveness
Praveen Dhakane, Rutuja Phulambrikar
Fluid responders, Fluid responsiveness, Hypoperfusion, Hypovolemia, Pulse pressure variation, Stroke volume variation, Velocity time integral
Citation Information :
Dhakane P, Phulambrikar R. Correlation between Carotid and Brachial Artery Velocity Time Integral and Their Comparison to Pulse Pressure Variation and Stroke Volume Variation for Assessing Fluid Responsiveness. Indian J Crit Care Med 2022; 26 (2):179-184.
Background: Fluid boluses are used in hemodynamically unstable patients with presumed hypovolemia, to improve tissue perfusion, in the perioperative period. Now less invasive methods, such as pulse pressure variation (PPV) and stroke volume variation (SVV) are increasingly being used. We investigated correlation between carotid and brachial artery velocity time integral (VTI) and compared both with PPV and SVV.
Methods: We recruited 27 patients undergoing supra-major abdominal surgeries. When indicated (hypotension or increased lactate), a fluid bolus was given after measuring carotid and brachial artery VTI, PPV, and SVV. The change in SV was noted and patients were categorized as responders if the SV increased by >15%. We performed Bland Altman Agreement and calculated best sensitivity and specificity for the parameters.
Results: Patients were found to be fluid responders on 29 instances. The correlation between PPV, SVV, carotid and brachial artery VTI was poor and the limits of agreement between them were wide. The Area under Curve (AUC) for PPV was 0.69, for SVV was 0.63, while those of Carotid and Brachial artery VTI (TAP and flow) were (0.53 and 0.54 for carotid) and (0.51 and 0.56 for brachial) respectively.
Conclusion: We found poor agreement and weak correlation between both VTi (TAP and flow) measured at carotid and brachial arteries, suggesting that the readings at brachial vessel cannot be used interchangeably with those at carotid artery. The PPV and SVV were better than these parameters for predicting fluid responsiveness; however, their predictive ability (AUROC), sensitivity and specificity were much lower than previously reported. Further studies in this area are therefore required (CTRI Reg No: CTRI/2017/08/009243).
Marik PE, Monnet X, Teboul JL. Hemodynamic parameters to guide fluid therapy. Ann Intensive Care 2011;1(1):1. DOI: 10.1186/2110-5820-1-1.
Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, et al. Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 2000;162(1):134–138. DOI: 10.1164/ajrccm.162.1.9903035.
Kumar A, Anel R, Bunnell E, Habet K, Zanotti S, Marshall S, et al. Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects. Crit Care Med 2004;32(3):691–699. DOI: 10.1097/01.ccm.0000114996.68110.c9.
Osman D, Ridel C, Ray P, Monnet X, Anguel N, Richard C, et al. Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge. Crit Care Med 2007;35(1):64–68. DOI: 10.1097/01.CCM.0000249851.94101.4F.
Kim KM, Gwak MS, Choi SJ, Kim MH, Park MH, Heo BY. Pulse pressure variation and stroke volume variation to predict fluid responsiveness in patients undergoing carotid endarterectomy. Korean J Anesthesiol 2013;65(3):237–243. DOI: 10.4097/kjae.2013.65.3.237.
De Backer D, Heenen S, Piagnerelli M, Koch M, Vincent JL. Pulse pressure variations to predict fluid responsiveness: influence of tidal volume. Intensive Care Med 2005;31(4):517–523. DOI: 10.1007/s00134-005-2586-4.
Scheer B, Perel A, Pfeiffer UJ. Clinical review: complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring in anaesthesia and intensive care medicine. Crit Care 2002;6(3):199–204. DOI:10.1186/cc1489.
Wang J, Zhou D, Gao Y, Wu Z, Wang X, Lv C. Effect of VTILVOT variation rate on the assessment of fluid responsiveness in septic shock patients. Medicine (Baltimore) 2020;99(47):e22702. DOI: 10.1097/MD.0000000000022702.
Blehar DJ, Glazier S, Gaspari RJ. Correlation of corrected flow time in the carotid artery with changes in intravascular volume status. J Crit Care 2014;29(4):486–488. DOI: 10.1016/j.jcrc.2014.03.025.
Monge García MI, Gil Cano A, Díaz Monrové JC. Brachial artery peak velocity variation to predict fluid responsiveness in mechanically ventilated patients. Crit Care 2009;13(5):R142. DOI: 10.1186/cc8027.
Brennan JM, Blair JE, Hampole C, Goonewardena S, Vasaiwala S, Shah D, et al. Radial artery pulse pressure variation correlates with brachial artery peak velocity variation in ventilated subjects when measured by internal medicine residents using hand-carried ultrasound devices. Chest 2007;131(5):1301–1307. DOI: 10.1378/chest.06-1768.
Futier E, Constantin JM, Paugam-Burtz C, Pascal J, Eurin M, Neuschwander A, et al; IMPROVE Study Group. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med 2013;369(5):428–437. DOI: 10.1056/NEJMoa1301082.
Serpa Neto A, Hemmes SN, Barbas CS, Beiderlinden M, Biehl M, Binnekade JM, et al; PROVE Network Investigators. Protective versus conventional ventilation for surgery: a systematic review and individual patient data meta-analysis. Anesthesiology 2015;123(1): 66–78. DOI: 10.1097/ALN.0000000000000706.
Guay J, Ochroch EA, Kopp S. Intraoperative use of low volume ventilation to decrease postoperative mortality, mechanical ventilation, lengths of stay and lung injury in adults without acute lung injury. Cochrane Database Syst Rev 2018;7(7):CD011151. DOI: 10.1002/14651858.CD011151.pub3.
Deng QW, Tan WC, Zhao BC, Wen SH, Shen JT, Xu M. Intraoperative ventilation strategies to prevent postoperative pulmonary complications: a network meta-analysis of randomised controlled trials. Br J Anaesth 2020;124(3):324–335. DOI: 10.1016/j.bja.2019.10.024.
Alvarado Sánchez JI, Caicedo Ruiz JD, Diaztagle Fernández JJ, Ospina-Tascón GA, Cruz Martínez LE. Use of pulse pressure variation as predictor of fluid responsiveness in patients ventilated with low tidal volume: a systematic review and meta-analysis. Clin Med Insights Circ Respir Pulm Med 2020;14:1179548420901518. DOI: 10.1177/1179548420901518.
Myatra SN, Prabu NR, Divatia JV, Monnet X, Kulkarni AP, Teboul JL. The changes in pulse pressure variation or stroke volume variation after a “tidal volume challenge” reliably predict fluid responsiveness during low tidal volume ventilation. Crit Care Med 2017;45(3):415–421. DOI: 10.1097/CCM.0000000000002183.
Liu Y, Wei LQ, Li GQ, Yu X, Li GF, Li YM. Pulse pressure variation adjusted by respiratory changes in pleural pressure, rather than by tidal volume, reliably predicts fluid responsiveness in patients with acute respiratory distress syndrome. Crit Care Med 2016;44(2):342–351. DOI: 10.1097/CCM.0000000000001371.
Charron C, Fessenmeyer C, Cosson C, Mazoit JX, Hebert JL, Benhamou D, et al. The influence of tidal volume on the dynamic variables of fluid responsiveness in critically ill patients. Anesth Analg 2006;102(5): 1511–1517. DOI: 10.1213/01.ane.0000209015.21418.f4.
Freitas FG, Bafi AT, Nascente AP, Assunção M, Mazza B, Azevedo LC, et al. Predictive value of pulse pressure variation for fluid responsiveness in septic patients using lung-protective ventilation strategies. Br J Anaesth 2013;110(3):402–408. DOI: 10.1093/bja/aes398.
Oliveira-Costa CD, Friedman G, Vieira SR, Fialkow L. Pulse pressure variation and prediction of fluid responsiveness in patients ventilated with low tidal volumes. Clinics (Sao Paulo) 2012;67(7):773–778. DOI: 10.6061/clinics/2012(07)12.