Evaluation of carotid flow time to assess fluid responsiveness in the emergency department

• Main Authors: P Immanuel Judson, Kundavaram Paul Prabhakar Abhilash, Kishore Pichamuthu, Gina Maryann Chandy
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2021-01-01
• Series: Journal of Medical Ultrasound
• Subjects: carotid blood flow; carotid flow time; doppler; emergency department; fluid responsiveness
• Online Access: http://www.jmuonline.org/article.asp?issn=0929-6441;year=2021;volume=29;issue=2;spage=99;epage=104;aulast=Judson
• ISSN: 0929-6441; 2212-1552

Background: Assessing fluid responsiveness in critically ill patients is challenging. Objective, noninvasive tests that are easy to perform are needed. Doppler measurements of dynamic carotid artery parameters such as carotid blood flow (CBF) and carotid flow time (CFT) are being studied as the potential indicators of volume responsiveness, but the data supporting its use are sparse. Methods: This prospective, observational study was conducted in the adult emergency department from June to September 2018. Patients who were prescribed a bolus of 500 ml of crystalloid for any indication were enrolled. Carotid Doppler was performed before and after a fluid bolus to measure the change in CBF and CFT. The aim of our study was to determine if CFT can be used as a marker of fluid responsiveness. Results: During the 4-month study period, 209 patients were recruited through convenient sampling after obtaining informed written consent. 29.6% of patients presented with a mean arterial pressure (MAP) <65, among whom 58.1% had septic shock. The baseline CBF was 643.0 ± 212.7 ml/min, and it was 583.9 ± 207.1 ml/min and 668 ± 210.8 ml/min in hypotensive and normotensive patients, respectively. Considering a >10% increase in CBF as fluid response, there were 59% responders and 41% nonresponders. The MAP increased by 9.5% in the responders, while there was no significant change in CFT after the fluid bolus. There was no difference in CFT among the responders as compared to the nonresponders. There was no correlation between the change of CBF and CFT (r[207] = 0.013, P = 0.061) after the fluid bolus. Conclusion: Though easy to perform, CFT is probably not a good indicator of fluid responsiveness.