VALUE OF CORRECTED FLOW TIME IN COMMON CAROTID ARTERY IN PREDICTING VOLUME RESPONSIVENESS UNDER MECHANICAL...

Objective: The present study aimed to investigate whether corrected flow time (FTc) in common carotid artery could predict volume responsiveness under mechanical ventilation and to further explore whether the sensitivity and specificity would be influenced by positive end-expiratory pressure (PEEP). Methods: The first stage of this study included 80 patients from the general surgery department undergoing laparotomy. After induction of general anesthesia, FTc in the common carotid artery was measured when hemodynamic indicators, such as blood pressure, heart rate, and cardiac output (CO), were stabilized. Then, 7 mg/kg (ideal body weight) of hydroxyethyl starch 130/0.4 sodium chloride was rapidly infused from the peripheral venous system. The infusion was completed within 15 minutes, and hemodynamic indicators were measured again immediately to evaluate volume responsiveness. The patients with change rate of CO (ΔCO ≥15%) were categorized into the responsive (R) group, whereas those with ΔCO <15% were categorized into the nonresponsive group (NR) group. In the second stage, 29 patients undergoing laparotomy were included. After induction of general anesthesia, PEEP of 0, 5, and 10 cmH 2 O was applied sequentially. Corrected flow time and hemodynamic indicators were recorded. Then, 7 mg/g of hydroxyethyl starch 130/0.4 sodium chloride was rapidly infused for 15 minutes, after which PEEP of 0, 5, and 10 cmH 2 O was applied sequentially, and the indicators were measured again. The patients with FTc equal to or less than the threshold in the first stage were categorized into the R group, otherwise into the NR group. Results: In the first stage of the study, CO and FTc differed significantly between the 2 groups, before and after volume load ( P < 0.05). Mean arterial pressure in the R group was significantly different, whereas heart rate did not differ before and after fluid infusion. Also, heart rate and mean arterial pressure were not significantly different before and after fluid infusion in the NR group. The area under the receiver operating characteristic curve was 0.786 ± 0.056 (95% confidence interval, 0.676-0.896; P = 0.00) for FTc before infusing volume load for predicting volume responsiveness. In the second stage of the study, PEEP did not have significant effects on FTc ( F2, 56 = 1.930, P = 0.155), whereas volume load had statistically significant effects on FTc ( F1, 28 ) = 9.381, P < 0.05). Moreover, FTc differed significantly different before and after fluid infusion ( P < 0.05). The area under the receiver operating characteristic curve for FTc in predicting volume responsiveness was 0.921, 0.805, and 0.719 when PEEP was 0, 5, and 10 cmH 2 O ( P < 0.05), respectively, and the cutoff value of FTc for diagnosing volume responsiveness was 323.42 milliseconds, 326.69 milliseconds, and 312.03 milliseconds, respectively. Conclusion: Corrected flow time in the common carotid artery can predict volume responsiveness under mechanical ventilation, and the predictive performance is not influenced by PEEP. Clinical Trial Registration Clinical register number: ChicTR2000029519.