Evaluating the Diagnostic Sensitivity of Doppler Ultrasonography of Carotid Artery in Determining the Adequacy of Shock Therapy Compared to Central Venous Catheter in Two Centers in Sanandaj
Iranian Journal of Emergency Medicine,
Vol. 7 No. 1 (2020),
28 March 2020
,
Page e19
https://doi.org/10.22037/ijem.v7i1.25285
Abstract
Introduction: Adjustment of vascular fluid volume in patients with severe injuries or admission to intensive care unit is difficult and vital. The aim of this study was to determine the diagnostic sensitivity of carotid artery Doppler ultrasonography in determining the adequacy of shock therapy compared to central venous catheter in hospitals of Sanandaj in 2018. Methods: In a descriptive-analytical study, 112 patients with hypovolemic shock (due to sepsis and ...) were evaluated in Tohid and Koswar Hospitals, Sanandaj from March to September 2018. To determine the flow intensity of carotid arteries, initially an echo device was used to collect the data since a portable ultrasonography device was not available but when it became available, the study was performed using portable ultrasonography devices. The study population included patients with hypovolemic shock (due to sepsis) presenting to Tohid and Kowsar hospitals, Sanandaj during 6 months. Trauma patients and those with cardiogenic shock and embolism-related shock were excluded. After the initial training of an emergency medicine resident by a radiologist, for all patients diagnosed with hypovolemic shock, the patient's characteristics including age, sex, blood pressure according to pressure gauge Mercury, heart rate per minute and inner diameter of the common carotid artery in systolic mode based on Doppler ultrasound were recorded. Then, the patient was treated based on the standard procedure using central venous catheter, and each time the fluid was administered, the flow intensity of the of the common carotid artery was calculated using the measured diameter and compared with the present method/Central venous catheter. The adequacy of treatment was confirmed when central venous pressure reached 8 to 15 after fluid therapy. Considering the normal distribution of quantitative data, "independent t-test" and "Pearson correlation coefficient" were used to analyze the hypotheses; and Chi-square test was used to evaluate the correlation between qualitative variables. Sensitivity and specificity were calculated using their respective formulas. The statistical software used was SPSS v.22. The study was approved by the ethics committee of Kurdistan University of Medical Sciences. Results: The results showed that 45.60% were female and the mean age of the population was 75.88 ± 10.82 years. The mean and standard deviation of the central venous pressure before and after shock therapy was 6.12 ± 0.65 and 7.88 ± 1.37, respectively. The mean diameter of the artery and flow intensity before and after lifting the foot were 6.92 ± 0.65, 7.37 ± 1.48 and 8.33 ± 1.81, respectively. Sensitivity, specificity and accuracy were 65.0%, 70.0% and 74.0%, respectively. Other results of the study showed that there was a significant positive correlation between findings of intravenous catheter and Doppler ultrasonography after treatment (r = 0.288, p = 0.002). Conclusion: The results of our study indicated that the sensitivity and specificity of Doppler ultrasonography were somehow acceptable in determining the adequacy of treatment, but more studies are recommended to confirm this.
- Ultrasonography
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References
Kariman H, Heidarian A, Majidi A, Hatamabadi H, Dolatabadi AA, Azar BNF. Accuracy of inferior vena cava, aorta, and jugular vein ultrasonographic diameters in identifying pediatric dehydration. Iranian Journal of Emergency Medicine. 2015;2(4):174-81.
Baratloo A, Rahmati F, Rouhipour A, Motamedi M, Gheytanchi E, Amini F, et al. Correlation of blood gas parameters with central venous pressure in patients with septic shock; a pilot study. Bulletin of emergency & trauma. 2014;2(2):77.
Hall JE. Guyton and Hall textbook of medical physiology e-Book: Elsevier Health Sciences; 2010.
Hosenpud JD, Greenberg BH. Congestive heart failure: Lippincott Williams & Wilkins; 2007.
Goldman L, Ausiello D. Cecil Textbook of Medicine. 22nd ed2004. p. 669-76.
Brunicardi FC, Schwartz SI. Schwartzs principles of surgery. 8th ed: McGraw-hill; 2005. p. 97-8.
Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. Harrison's principles of internal medicine, 19e. 16th ed2005. p. 1601-6.
Downey DB. The retroperitoneum and great vessels. Diagnostic Ultrasound Philadelphia, PA, USA: Mosby, Inc. 3rd ed2003. p. 478-80.
Alsous F, Khamiees M, DeGirolamo A, Amoateng-Adjepong Y, Manthous CA. Negative fluid balance predicts survival in patients with septic shock. Chest. 2000;117(6):1749-54.
Salahuddin N, Chishti I, Siddiqui S. Determination of intravascular volume status in critically ill patients using portable chest X-rays: measurement of the vascular pedicle width. Critical Care. 2007;11(2):P282.
Peachey T, Tang A, Baker EC, Pott J, Freund Y, Harris T. The assessment of circulating volume using inferior vena cava collapse index and carotid Doppler velocity time integral in healthy volunteers: a pilot study. Scandinavian journal of trauma, resuscitation and emergency medicine. 2016;24(1):108.
Miller JB, Lee A, Suszanski JP, Tustian M, Corcoran JL, Moore S, et al. Challenge of intravascular volume assessment in acute ischemic stroke. The American journal of emergency medicine. 2018;36(6):1018-21.
Yousefifard M, Baikpour M, Ghelichkhani P, Asady H, Darafarin A, Esfahani MRA, et al. Comparison of ultrasonography and radiography in detection of thoracic bone fractures; a systematic review and meta-analysis. Emergency. 2016;4(2):55.
Rahimi-Movaghar V, Yousefifard M, Ghelichkhani P, Baikpour M, Tafakhori A, Asady H, et al. Application of ultrasonography and radiography in detection of hemothorax; a systematic review and meta-analysis. Emergency. 2016;4(3):116.
Ebrahimi A, Yousefifard M, Kazemi HM, Rasouli HR, Asady H, Jafari AM, et al. Diagnostic accuracy of chest ultrasonography versus chest radiography for identification of pneumothorax: a systematic review and meta-analysis. Tanaffos. 2014;13(4):29.
Hosseini M, Ghelichkhani P, Baikpour M, Tafakhori A, Asady H, Ghanbari MJH, et al. Diagnostic accuracy of ultrasonography and radiography in detection of pulmonary contusion; a systematic review and meta-analysis. Emergency. 2015;3(4):127.
Naghipour B, Faridaalaee G. Correlation between central venous pressure and inferior vena cava sonographic diameter; determining the best anatomic location. Emergency. 2016;4(2):83.
Haghighi SHO, Begi HRM, Sorkhabi R, Tarzamani MK, Zonouz GK, Mikaeilpour A, et al. Diagnostic accuracy of ultrasound in detection of traumatic lens dislocation. Emergency. 2014;2(3):121.
Golshani K. Diagnostic accuracy of Optic Nerve Ultrasonography and Ophthalmoscopy in prediction of elevated intracranial pressure. Emergency. 2015;3(2):54.
Luboch M, Łoś M, Szmygel Ł, Kosiak W. Sonographic assessment of the inferior vena cava/aorta index measured with the transducer placed in the anterior median line and right anterior axillary line–a comparison. Journal of ultrasonography. 2014;14(58):280.
Joels CS, Sing RF, Heniford BT. Complications of inferior vena cava filters. The American Surgeon. 2003;69(8):654.
Shokoohi H, Berry GW, Shahkolahi M, King J, King J, Salimian M, et al. The diagnostic utility of sonographic carotid flow time in determining volume responsiveness. Journal of critical care. 2017;38:231-5.
Marik PE, Levitov A, Young A, Andrews L. The use of bioreactance and carotid Doppler to determine volume responsiveness and blood flow redistribution following passive leg raising in hemodynamically unstable patients. Chest. 2013;143(2):364-70.
Ma IW, Caplin JD, Azad A, Wilson C, Fifer MA, Bagchi A, et al. Correlation of carotid blood flow and corrected carotid flow time with invasive cardiac output measurements. Critical ultrasound journal. 2017;9(1):10.
Lu N, Xi X, Jiang L, Yang D, Yin K. Exploring the best predictors of fluid responsiveness in patients with septic shock. The American journal of emergency medicine. 2017;35(9):1258-61.
Stolz LA, Mosier JM, Gross AM, Douglas MJ, Blaivas M, Adhikari S. Can emergency physicians perform common carotid Doppler flow measurements to assess volume responsiveness? Western Journal of Emergency Medicine. 2015;16(2):255.
Angirekula VRK, Shaman Z. Carotid Flow Measurement Variability in Shock Using Point of Care Ultrasound. Chest. 2016;150(4):296A.
Zengin S, Al B, Genc S, Yildirim C, Ercan S, Dogan M, et al. Role of inferior vena cava and right ventricular diameter in assessment of volume status: a comparative study: ultrasound and hypovolemia. The American journal of emergency medicine. 2013;31(5):763-7.
Baumann UA, Marquis C, Stoupis C, Willenberg TA, Takala J, Jakob SM. Estimation of central venous pressure by ultrasound. Resuscitation. 2005;64(2):193-9.
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