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Carotid Doppler Ultrasonography for Hemodynamic Assessment in Critically Ill Children
Aline Junqueira Rubio1, Luiza Lobo de Souza1, Roberto J N Nogueira1,2
1Pediatric Intensive Care Unit, Department of Pediatrics, State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo Street., Campinas, SP, 13083-887, Brazil.
Insights
Point-of-care ultrasonography of the common carotid artery (CCA) can estimate stroke volume (SV) and cardiac index (Ci) in critically ill children. This non-invasive method offers a viable alternative when traditional echocardiography is unavailable.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular physiology
- Medical imaging and diagnostics
Background:
- Accurate assessment of cardiovascular performance is crucial for managing critically ill children.
- Hemodynamic monitoring guides interventions and predicts patient response.
- Transthoracic echocardiography (TTE) is a standard but sometimes inaccessible tool.
Purpose of the Study:
- To evaluate point-of-care ultrasonography of the common carotid artery (CCA) for estimating stroke volume (SV) and cardiac index (Ci) in critically ill children.
- To determine the feasibility of using CCA Doppler ultrasonography as an alternative to TTE.
Main Methods:
- Prospective study involving 50 critically ill children.
- Doppler ultrasonography of the left CCA was performed.
- Measurements were compared with transthoracic echocardiography (TTE) derived SV and Ci.
- Carotid blood flow (CBF) and carotid corrected flow time (CFT) were calculated.
Main Results:
- Both systolic (CBF(s)) and total (CBF(t)) carotid blood flow demonstrated very strong correlations with SV (ρ=0.98, 0.97) and Ci (ρ=0.96, 0.92).
- Agreement analysis indicated clinically acceptable biases and percentage errors between TTE and CCA Doppler estimations.
- A linear regression equation was derived to estimate Ci in mechanically ventilated children using CCA Doppler data.
Conclusions:
- Doppler ultrasonography of the left CCA effectively estimates SV and Ci in critically ill children.
- CCA Doppler ultrasonography serves as a practical alternative for Ci estimation when TTE is not feasible or available.
- This point-of-care technique enhances hemodynamic assessment capabilities in pediatric critical care settings.
Abstract:
An accurate assessment of cardiovascular performance is essential to predict and evaluate hemodynamic response to interventions. The objective of this prospective study was to assess whether point-of-care ultrasonography of the common carotid artery (CCA) can estimate the stroke volume (SV) and cardiac index (Ci) of critically ill children. Participants underwent Doppler ultrasonography of the left CCA and transthoracic echocardiography (TTE). Variables measured by TTE were SV and Ci. Carotid blood flow (CBF) was calculated based on both systolic velocity-time integral (CBF(s)) and total velocity-time integral (CBF(t)). Carotid corrected flow time(CFT)was also determined. A total of 50 children were enrolled. The median age and weight of participants were 36.0 months and 14.2 kg, respectively. Both CBF(s) and CBF(t) correlated very strongly with SV (ρ = 0.98 and 0.97, respectively) and Ci (ρ = 0.96 and 0.92, respectively). Agreement analysis showed low biases and clinically acceptable percentage errors between variables measured by TTE (SV and Ci) and those estimated by Doppler ultrasonography. Linear regression analysis revealed that the Ci of mechanically ventilated children can be estimated by the following equation: [Formula: see text]. CFT did not significantly correlate with SV or Ci (ρ = 0.27 and 0.05, respectively). Doppler ultrasonography of the left CCA is able to estimate the SV and Ci of critically ill children. Therefore, the CDU may be considered as an alternative for estimating Ci in critically ill children when TTE is not feasible or available.
