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Carotid Artery Flow Time Measured by Point-of-Care Ultrasound Correlates with Volume Changes in Pediatric
Amit K Patel1, Kirtida Mistry2, Kristen Breslin1
1Division of Pediatric Emergency Medicine and Trauma Services, Children's National Health System, George Washington University, School of Medicine and Health Sciences, Washington, DC, USA.
Insights
Carotid artery flow time corrected for heart rate (CFTc) can help assess fluid status in children undergoing hemodialysis. Changes in CFTc moderately correlate with intravascular volume reduction after dialysis.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Physiology
- Point-of-Care Ultrasound
Background:
- Carotid artery flow time corrected for heart rate (CFTc) is a validated indicator of intravascular volume in adults.
- Its utility in pediatric populations, particularly those with chronic conditions like kidney disease, remains under-investigated.
Purpose of the Study:
- To investigate the correlation between CFTc and fluid status changes in pediatric patients undergoing chronic hemodialysis.
- To evaluate CFTc as a potential non-invasive tool for monitoring fluid volume in this population.
Main Methods:
- Prospective observational study of pediatric patients (5-18 years) on chronic hemodialysis.
- CFTc measured using point-of-care ultrasound before and after hemodialysis sessions.
- Passive leg raise maneuver also assessed for CFTc changes.
Main Results:
- A significant decrease in CFTc was observed post-hemodialysis (21.7 ms, p < 0.001).
- Pre- and post-dialysis CFTc changes showed a moderate correlation with the volume of fluid removed during dialysis (R² = 0.224, p = 0.03).
- No significant CFTc change was noted with passive leg raise.
Conclusions:
- Changes in CFTc are moderately correlated with intravascular volume reduction in pediatric patients post-hemodialysis.
- CFTc shows promise as a tool for assessing fluid status in children undergoing hemodialysis.
- Further research is warranted to validate CFTc in pediatric fluid management.
Abstract:
Carotid artery flow time corrected for heart rate (CFTc) correlates with intravascular volume changes in adults but has not been studied adequately in the pediatric population. We studied how fluid status changes correlate with CFTc in pediatric patients undergoing hemodialysis. This prospective observational study involved pediatric patients aged 5-18 y undergoing chronic hemodialysis at a tertiary care children's hospital in the United States. We measured CFTc by point-of-care ultrasound before and after each hemodialysis session, including passive leg raise. One hundred sixty-eight CFTc measurements were obtained from a total of 21 patient encounters. Post-dialysis CFTc decreased by 21.7 ms (95% confidence interval: 12.3-31.0) (p < 0.001). Pre- and post-dialysis ∆CFTc measurements were proportionally correlated with volume removed in dialysis adjusted for weight (mL/kg) (R2 = 0.224, p = 0.03). There was no significant change in mean CFTc with passive leg raise before or after hemodialysis. In children on hemodialysis, changes in CFTc were moderately correlated with decrease in intravascular volume after hemodialysis.
