Abstract

Observational Study

Alternatives to Apical View in Predicting Fluid Responsiveness by Transthoracic Echocardiography: An Observational Study

Haimeur Yassine*, Aberouch Larbi, Tadili Jawad, Faroudy Mamoun and El Kettani Ali

Published: 14 May, 2025 | Volume 10 - Issue 1 | Pages: 006-012

Introduction: Flow analysis in the apical view of transthoracic echocardiography is validated to assess fluid responsiveness at the bedside. Still, it is not always reachable, especially in mechanically ventilated patients and during surgery. We compared it to supra-sternal and sub-xiphoid views to evaluate their validity in assessing fluid responsiveness in critically ill patients.
Method: A cross-sectional prospective monocentric pilot study of three months duration has been led in the critical care unit for surgical emergencies of Ibn Sina University Hospital of Rabat (Morocco). We used the time-velocity index (VTI) and peak velocity variation (∆Vpeak) values correlation between the three acoustic windows as the main judgment criteria. Measurement of data was made in the Left Ventricle Outflow Tract (LVOT) in the 5-chamber apical view, Descending Thoracic Aorta (DTA) in the supra-sternal view, and Right Ventricle Outflow Tract (RVOT) in the sub-xiphoid view.
Results: There were 14 adult patients involved in the study, and the data presented are preliminary results. There was no significant difference in VTI and ∆Vpeak values between the three acoustic windows at each time of the study protocol, with a very high correlation for initial VTI value between 5-chamber apical view and supra-sternal view (r = 0.96, p < 0.001), and sub-xiphoid view (r = 0.86, p < 0.001). A very high correlation of initial ∆Vpeak value was also observed between the 5-chamber apical view and supra-sternal view (rho = 0.89, p < 0.001) and sub-xiphoid view (rho = 0.79, p < 0.001).
Discussion: Supra-sternal and sub-xiphoid views showed high potential to predict fluid responsiveness, but further data are needed to validate their use for this purpose in ICU and in operating room.

Read Full Article HTML DOI: 10.29328/journal.jcicm.1001052 Cite this Article Read Full Article PDF

Keywords:

Fluid responsiveness; Supra-sternal view; Sub-xiphoid view; Velocity-time integral; Peak velocity variation

References

  1. Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med. 2011;39(2):259–65. Available from: https://doi.org/10.1097/ccm.0b013e3181feeb15
  2. Silva JM, de Oliveira AM, Nogueira FA, Vianna PM, Pereira Filho MC, Dias LF, et al. The effect of excess fluid balance on the mortality rate of surgical patients: a multicenter prospective study. Crit Care. 2013;17:R288. Available from: https://doi.org/10.1186/cc13151
  3. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354(24):2564–75. Available from: https://doi.org/10.1056/nejmoa062200
  4. Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, Hofer C, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40(12):1795–815. Available from: https://doi.org/10.1007/s00134-014-3525-z
  5. Monnet X, Marik PE, Teboul JL. Prediction of fluid responsiveness: an update. Ann Intensive Care. 2016;6:111. Available from: https://doi.org/10.1186/s13613-016-0216-7
  6. Broch O, Renner J, Gruenewald M, Meybohm P, Höcker J, Schöttler J, et al. Variation of left ventricular outflow tract velocity and global end-diastolic volume index reliably predict fluid responsiveness in cardiac surgery patients. J Crit Care. 2012;27(3):325.e7–13. Available from: https://doi.org/10.1016/j.jcrc.2011.07.073
  7. Desai N, Garry D. Assessing dynamic fluid-responsiveness using transthoracic echocardiography in intensive care. BJA Educ. 2018;18(7):218–26. Available from: https://doi.org/10.1016/j.bjae.2018.03.005
  8. Schober P, Loer SA, Schwarte LA. Haemodynamic monitoring of critically ill patients with transoesophageal Doppler technology. Neth J Crit Care. 2010;14:388–94. Available from: https://doi.org/10.1213/ane.0b013e3181aa0af3
  9. De Backer D, Heenen S, Piagnerelli M, Koch M, Vincent JL. Pulse pressure variations to predict fluid responsiveness: influence of tidal volume. Intensive Care Med. 2005;31(4):517–23. Available from: https://doi.org/10.1007/s00134-005-2586-4
  10. Galderisi M, Henein MY, D'hooge J, Sicari R, Badano LP, Zamorano JL, et al. Recommendations of the European Association of Echocardiography. How to use echo-Doppler in clinical trials: different modalities for different purposes. Eur J Echocardiogr. 2011;12(5):339–53. Available from: https://doi.org/10.1093/ejechocard/jer051
  11. Blanco P. Rationale for using the velocity–time integral and the minute distance for assessing the stroke volume and cardiac output in point-of-care settings. Ultrasound J. 2020;12:21. Available from: https://doi.org/10.1186/s13089-020-00170-x
  12. Souto R, Melo WB, Freire CMV, Vilas Boas WW. Comparative study between suprasternal and apical windows: a user-friendly cardiac output measurement for the anesthesiologist. Braz J Anesthesiol. 2021:S0104-0014(21)00264-5. Available from: https://doi.org/10.1016/j.bjane.2021.02.063
  13. Samra T, Deepak R, Jayant A, Saini V. The utility of limited trans-thoracic echocardiography in the stratification of pulse pressure variation: A feasibility study in major open abdominal surgery. Saudi J Anaesth. 2018;12(4):584–92. Available from: https://doi.org/10.4103/sja.sja_686_17
  14. Cheong I, Otero Castro V, Brizuela M, Früchtenicht MF, Merlo PM, Tamagnone FM. Passive leg raising test to predict fluid responsiveness using the right ventricle outflow tract velocity-time integral through a subcostal view. J Ultrasound. 2022 Sep 21. Epub ahead of print. PMID: 36127570. Available from: https://doi.org/10.1007/s40477-022-00719-7

Figures:

Figure 1

Figure 1

Figure 1

Figure 2

Figure 1

Figure 3

Figure 1

Figure 4

Figure 1

Figure 5

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?
Chat with us on WhatsApp!×
Do you have any interest to know journal impact factor?