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Surrogate indices of aortic peak systolic velocity variation to monitor fluid responsiveness in pediatric non-cardiac surgery: a prospective observational study

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Abstract

Aortic peak systolic velocity variation (ΔVpeakAo) is a reliable dynamic indicator of preload in mechanically ventilated children. However, easily measurable alternative parameters like carotid peak systolic velocity variation (ΔVpeakCa) and suprasternal peak systolic velocity variation (ΔVpeakSs) are not well evaluated in children. The aim of the study was to find correlation between ΔVpeakCa and ΔVpeakSs to ΔVpeakAo, as potential surrogate markers of fluid responsiveness. 52 children, 1–12 years old, undergoing major non-cardiac surgeries under general endotracheal anaesthesia were recruited for this single-centre prospective observational study. ΔVpeakAo, ΔVpeakCa and ΔVpeakSs were measured by pulsed wave Doppler in appropriate windows, measuring maximum and minimum peak flow velocity over a single respiratory cycle. Calculated parameters were compared by a repeated measures study design. Correlation coefficients were 0.82 between ΔVpeakAo and ΔVpeakSs and 0.73 between ΔVpeakAo and ΔVpeakCa. Bland–Altman analysis showed minimal bias of 1.86 percentage points with limits of agreement of 11.21 to − 7.49 (ΔVpeakAo and ΔVpeakSs) and 3.93 percentage points with limits of agreement of 14.04 to − 6.18 (ΔVpeakAo and ΔVpeakCa). ΔVpeakSs and ΔVpeakCa also showed good discrimination to predict ΔVpeakAo (lying in previously validated fluid responsive zones) with sensitivities and specificities of 82.25% and 85% with cut-off of 11% for ΔVpeakSs, and 88.52% and 70% with cut-off of 8.6% for ΔVpeakCa. Carotid peak systolic velocity variation (ΔVpeakCa) and suprasternal peak systolic velocity variation (ΔVpeakCa) can be potential surrogate markers for Aortic peak systolic velocity variation (ΔVpeakAo) in assessing fluid responsiveness in mechanically ventilated children.

Study registration: Clinicaltrials.gov ID NCT03155555.

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Data availability

The dataset used and analysed in the present study is available from the corresponding author on request.

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Authors and Affiliations

  1. Department of Anaesthesia and Intensive Care, PGIMER Chandigarh, Sector 12, Chandigarh, 160011, India

    Subhrashis Guha Niyogi, Indu Mohini Sen, Banashree Mandal, Neerja Bhardwaj, Sandhya Yaddanapudi & Preethy Mathew

  2. Department of Anaesthesiology and Critical Care Medicine, Amrita Institute of Medical Sciences and Research Centre, Peeliyadu Road, Ponekkara, Edappally, Kochi, Kerala, 682041, India

    Aveek Jayant

Authors
  1. Subhrashis Guha Niyogi
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  2. Indu Mohini Sen
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  3. Aveek Jayant
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  4. Banashree Mandal
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  5. Neerja Bhardwaj
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Correspondence to Indu Mohini Sen.

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None of the authors have any conflicts of interest to report.

Ethical approval

All procedures performed in studies involving human participants were reviewed and approved by the Institutional Ethical Committee and were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Institutional Ethical Committee approval (INT/IEC/2016/2525) was obtained.

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Informed consent was obtained from the legal guardians of all individual participants included in the present study.

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Niyogi, S.G., Sen, I.M., Jayant, A. et al. Surrogate indices of aortic peak systolic velocity variation to monitor fluid responsiveness in pediatric non-cardiac surgery: a prospective observational study. J Clin Monit Comput 34, 1159–1166 (2020). https://doi.org/10.1007/s10877-019-00431-8

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  • DOI: https://doi.org/10.1007/s10877-019-00431-8

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