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BMC Pregnancy and Childbirth

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Open Access 01-12-2024 | Sectio Caesarea | Research

Predicting fluid responsiveness in spontaneously breathing parturients undergoing caesarean section via carotid artery blood flow and velocity time integral measured by carotid ultrasound: a prospective cohort study

Authors: Shaobing Dai, Chun Wang, Xia Tao, Jianjun Shen, Lili Xu

Published in: BMC Pregnancy and Childbirth | Issue 1/2024

Abstract

Background

Present evidence suggests that the Doppler ultrasonographic indices, such as carotid artery blood flow (CABF) and velocity time integral (VTI), had the ability to predict fluid responsiveness in non-obstetric patients. The purpose of this study was to assess their capacity to predict fluid responsiveness in spontaneous breathing parturients undergoing caesarean section and to determine the effect of detecting and management of hypovolemia (fluid responsiveness) on the incidence of hypotension after anaesthesia.

Methods

A total of 72 full term singleton parturients undergoing elective caesarean section were enrolled in this study. CABF, VTI, and hemodynamic parameters were recorded before and after fluid challenge and assessed by carotid artery ultrasonography. Fluid responsiveness was defined as an increase in stroke volume index (SVI) of 15% or more after the fluid challenge.

Results

Thirty-one (43%) patients were fluid responders. The area under the ROC curve to predict fluid responsiveness for CABF and VTI were 0.803 (95% CI, 0.701–0.905) and 0.821 (95% CI, 0.720–0.922). The optimal cut-off values of CABF and VTI for fluid responsiveness was 175.9 ml/min (sensitivity of 74.0%; specificity of 78.0%) and 8.7 cm/s (sensitivity of 67.0%; specificity of 90.0%). The grey zone for CABF and VTI were 114.2-175.9 ml/min and 6.8–8.7 cm/s. The incidence of hypotension after the combined spinal-epidural anaesthesia (CSEA) was significantly higher in the Responders group 25.8% (8/31) than in the Non-Responders group 17.1(7/41) (P < 0.001). The total incidence of hypotension after CSEA of the two groups was 20.8% (15/72).

Conclusions

Ultrasound evaluation of CABF and VTI seem to be the feasible parameters to predict fluid responsiveness in parturients undergoing elective caesarean section and detecting and management of hypovolemia (fluid responsiveness) could significantly decrease incidence of hypotension after anaesthesia.

Trial registration

The trial was registered at the Chinese Clinical Trial Registry (ChiCTR) (www.chictr.org), registration number was ChiCTR1900022327 (The website link: https://www.chictr.org.cn/showproj.html?proj=37271 ) and the date of trial registration was in April 5, 2019. This study was performed in accordance with the Declaration of Helsinki and approved by the Research Ethics Committee of Women’s Hospital, Zhejiang University School of Medicine (20,180,120).

Zieleskiewicz L, Noel A, Duclos G, Haddam M, Delmas A, Bechis C, et al. Can point-of-care ultrasound predict spinal hypotension during caesarean section? A prospective observational study. Anaesthesia. 2018;73(1):15–22.CrossRefPubMed

Wu M, Dai Z, Liang Y, Liu X, Zheng X, Zhang W, et al. Respiratory variation in the internal jugular vein does not predict fluid responsiveness in the prone position during adolescent idiopathic scoliosis surgery: a prospective cohort study. BMC Anesthesiol. 2023;23(1):360.CrossRefPubMedPubMedCentral

Bortolotti P, Colling D, Colas V, Voisin B, Dewavrin F, Poissy J, et al. Respiratory changes of the inferior vena cava diameter predict fluid responsiveness in spontaneously breathing patients with cardiac arrhythmias. Ann Intensive Care. 2018;8(1):79.CrossRefPubMedPubMedCentral

Weber T, Wagner T, Neumann K, Deusch E. Low predictability of three different noninvasive methods to determine fluid responsiveness in critically ill children. Pediatr Crit Care Med. 2015;16(3):e89–94.CrossRefPubMed

Kim DH, Shin S, Kim N, Choi T, Choi SH, Choi YS. Carotid ultrasound measurements for assessing fluid responsiveness in spontaneously breathing patients: corrected flow time and respirophasic variation in blood flow peak velocity. Br J Anaesth. 2018;121(3):541–9.CrossRefPubMed

Xu L, Dai S, Shen J, Lv C, Tang Y, Chen X. The predictive ability of carotid artery corrected flow time and respirophasic variation in blood flow peak velocity measured by ultrasonography for fluid responsiveness in parturients for cesarean delivery. Minerva Anestesiol. 2020;86(10):1039–46.CrossRefPubMed

Sidor M, Premachandra L, Hanna B, Nair N, Misra A. Carotid Flow as a surrogate for Cardiac output measurement in Hemodynamically stable participants. J Intensive Care Med. 2020;35(7):650–5.CrossRefPubMed

Ma IWY, 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. Crit Ultrasound J. 2017;9(1):10.CrossRefPubMedPubMedCentral

Fu Q. Hemodynamic and Electrocardiographic aspects of uncomplicated singleton pregnancy. Adv Exp Med Biol. 2018;1065:413–31.CrossRefPubMed

10.

Kuhn JC, Falk RS, Langesæter E. Haemodynamic changes during labour: continuous minimally invasive monitoring in 20 healthy parturients. Int J Obstet Anesth. 2017;31:74–83.CrossRefPubMed

11.

Fu F, Xiao F, Chen W, Yang M, Zhou Y, Ngan Kee WD, et al. A randomised double-blind dose-response study of weight-adjusted infusions of norepinephrine for preventing hypotension during combined spinal-epidural anaesthesia for caesarean delivery. Br J Anaesth. 2020;124(3):e108–14.CrossRefPubMed

12.

Myles PS, Bellomo R, Corcoran T, Forbes A, Peyton P, Story D, et al. Restrictive versus liberal fluid therapy for major abdominal surgery. N Engl J Med. 2018;378(24):2263–74.CrossRefPubMed

13.

Mercier FJ. Cesarean delivery fluid management. Curr Opin Anaesthesiol. 2012;25(3):286–91.CrossRefPubMed

14.

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. Scand J Trauma Resusc Emerg Med. 2016;24(1):108.CrossRefPubMedPubMedCentral

15.

Wang Y, Gao L, Li JB, Yu C. Assessment of left atrial function by full volume real-time three-dimensional echocardiography and left atrial tracking in essential hypertension patients with different patterns of left ventricular geometric models. Chin Med Sci J. 2013;28(3):152–8.CrossRefPubMed

16.

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.CrossRefPubMed

17.

Cheong I, Otero Castro V, Sosa FA, Tort Oribe B, Früchtenicht MF, Tamagnone FM et al. Passive leg raising test using the carotid flow velocity-time integral to predict fluid responsiveness. J Ultrasound(2023).

18.

Cannesson M, Le Manach Y, Hofer CK, Goarin JP, Lehot JJ, Vallet B, et al. Assessing the diagnostic accuracy of pulse pressure variations for the prediction of fluid responsiveness: a gray zone approach. Anesthesiology. 2011;115(2):231–41.CrossRefPubMed

19.

Coste J, Pouchot J. A grey zone for quantitative diagnostic and screening tests. Int J Epidemiol. 2003;32(2):304–13.CrossRefPubMed

20.

Soubrier S, Saulnier F, Hubert H, Delour P, Lenci H, Onimus T, et al. Can dynamic indicators help the prediction of fluid responsiveness in spontaneously breathing critically ill patients? Intensive Care Med. 2007;33(7):1117–24.CrossRefPubMed

21.

Preau S, Bortolotti P, Colling D, Dewavrin F, Colas V, Voisin B, et al. Diagnostic accuracy of the Inferior Vena Cava Collapsibility to Predict Fluid responsiveness in spontaneously breathing patients with Sepsis and Acute Circulatory failure. Crit Care Med. 2017;45(3):e290–7.CrossRefPubMed

22.

Pace R, Lassola S, Miori S, Cammarota G, Barbariol F, Vetrugno L. Carotid vs. aortic velocity time integral and peak velocity to predict fluid responsiveness in mechanically ventilated patients. A comparative study. Minerva Anestesiol. 2022;88(5):352–60.CrossRefPubMed

23.

Brun C, Zieleskiewicz L, Textoris J, Muller L, Bellefleur JP, Antonini F, et al. Prediction of fluid responsiveness in severe preeclamptic patients with oliguria. Intensive Care Med. 2013;39(4):593–600.CrossRefPubMed

24.

Feng S, Gu J, Yu C, Liu J, Ni J. Exploring the predictive value of combined ultrasound parameters for spinal anesthesia-induced hypotension in cesarean section: a prospective observational study. BMC Anesthesiol. 2023;23(1):255.CrossRefPubMedPubMedCentral

25.

Rubio AJ, de Souza LL, Nogueira RJN, Brandão MB, de Souza TH. Carotid Doppler Ultrasonography for hemodynamic Assessment in critically Ill Children. Pediatr Cardiol. 2022;43(2):382–90.CrossRefPubMed

26.

Gassner M, Killu K, Bauman Z, Coba V, Rosso K, Blyden D. Feasibility of common carotid artery point of care ultrasound in cardiac output measurements compared to invasive methods. J Ultrasound. 2014;18(2):127–33.CrossRefPubMedPubMedCentral

27.

Liteplo AS, Schleifer J, Marill KA, Huang CK, Gouker SK, Ratanski D, et al. Carotid ultrasound in assessing fluid responsiveness in patients with hypotension and suspected Sepsis. Shock. 2021;56(3):419–24.CrossRefPubMed

28.

Aya AGM, Vialles N, Tanoubi I, Mangin R, Ferrer JM, Robert C, et al. Spinal anesthesia-induced hypotension: a risk comparison between patients with severe preeclampsia and healthy women undergoing preterm cesarean delivery. Anesth Analg. 2005;101(3):869–75.CrossRefPubMed

29.

Belachew BG, Kasahun B, Demissie BW, Sintayhu A, Dendir G, Ali A, et al. Comparison of the hemodynamic changes between preeclamptic and normotensive parturients who underwent cesarean section under spinal anesthesia at North Showa Zone public hospitals, Oromia region, Ethiopia, 2022: a prospective cohort study. BMC Anesthesiol. 2023;23(1):387.CrossRefPubMedPubMedCentral

30.

Jin XQ, Shen YH, Fu F, Yu J, Xiao F, Huang XD. Oxytocin infusion for maintenance of uterine tone under prophylactic phenylephrine infusion for prevention of post-spinal hypotension in cesarean delivery: a prospective randomised double-blinded dose-finding study. BMC Pregnancy Childbirth. 2023;23(1):840.CrossRefPubMedPubMedCentral

31.

Ni HF, Liu HY, Zhang J, Peng K, Ji FH. Crystalloid coload reduced the incidence of hypotension in spinal anesthesia for cesarean delivery, when compared to crystalloid preload: a meta-analysis. BioMed Res Int. 2017;2017:3462529.CrossRefPubMedPubMedCentral

32.

Sheng ZM, Sun HQ, Mao JQ, Liu J, Liang G, Mei Z. Comparative dose-response study on the infusion of norepinephrine combined with intravenous ondansetron versus placebo for preventing hypotension during spinal anesthesia for cesarean section: a randomised controlled trial. Int J Surg(2023).

33.

Bishop DG. Predicting spinal hypotension during caesarean section. South Afr J Anaesth Analg. 2014;20(4):14–7.CrossRef

34.

Aslanlar E, Sargın M, Aslanlar DA, Önal Ö. Can subclavian/infraclavicular axillary vein collapsibility index predict spinal anesthesia-induced hypotension in cesarean-section operations? Eur Rev Med Pharmacol Sci. 2023;27(21):10411–8.PubMed

Title: Predicting fluid responsiveness in spontaneously breathing parturients undergoing caesarean section via carotid artery blood flow and velocity time integral measured by carotid ultrasound: a prospective cohort study
Authors: Shaobing Dai
Chun Wang
Xia Tao
Jianjun Shen
Lili Xu
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Sectio Caesarea
Sectio Ceasarea
Hypotension
Hypotension
Published in: BMC Pregnancy and Childbirth / Issue 1/2024
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-024-06246-z

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Predicting fluid responsiveness in spontaneously breathing parturients undergoing caesarean section via carotid artery blood flow and velocity time integral measured by carotid ultrasound: a prospective cohort study

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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