Corrected carotid flow time and passive leg raise as a measure of volume status.

BACKGROUND: The aim of this study was to investigate the value of corrected carotid flow time (FTc) with passive leg raise (PLR) as a non-invasive marker of volume status in end stage renal disease (ESRD) patients. METHODS: Prospective observational study of ESRD patients presenting to the Emergency department requiring hemodialysis. The common carotid artery was evaluated in long axis. Flow time measurements pre- and post-dialysis as well as before and after PLR were recorded. RESULTS: 54 patients were enrolled, of which, 30 (55%) were male. The mean age was 47.4 years. The mean volume of fluid removed was 3.89 ±â€¯0.91 L. In the pre-dialysis cohort, the mean FTc was 340.16 ms (95% CI, 330.36-349.95). Following PLR, the mean FTc was 341.34 ms (95% CI 331.74-350.94). In the post hemodialysis cohort, the mean FTc was 302.48 ms (95% CI, 293.63-311.32). Following the PLR maneuver, the mean FTc was 340.49 ms (95% CI 331.97-349.02). The mean decrease in corrected carotid flow time was 19.15 ms (95% CI, 22.86-41.17), 32.02 ms (95% CI 4.05-34.25) and 41.17 ms (95% CI, 36.47-54.76) for patients who had <3 L, 3-4 L and >4 L removed, respectively. In patients without CHF, the mean decrease in FTc after hemodialysis was 38.80 ms (95% CI, 30.12-47.49) whereas for CHF patients the mean decrease was 35.60 ms (95% CI, 25.05-46.15). CONCLUSION: Corrected flow time in conjunction with passive leg raise seem to correlate with volume status in hemodialysis patients.

Bedside Echocardiography and Passive Leg Raise as a Measure of Volume Responsiveness in the Emergency Department.

OBJECTIVES: The aim of this study was to investigate the value of bedside echocardiography with a passive leg raise as a noninvasive marker of volume responsiveness. METHODS: This work was a prospective observational study of patients with end-stage renal disease presenting to the emergency department. The left ventricular outflow tract (LVOT) velocity time integral (VTI) was obtained. Measurements before and after dialysis as well as before and after the passive leg raise were recorded. RESULTS: Fifty-four patients were enrolled, in whom the mean volume of fluid removed ± SD was 3.89 ± 0.91 L. In the predialysis cohort, the mean LVOT VTI was 28.05 cm (95% confidence interval [CI], 26.55-29.55 cm). After the passive leg raise, the mean VTI was 28.52 cm (95% CI, 26.98-30.07 cm). In the postdialysis cohort, the mean VTI was 30.31 cm (95% CI, 28.92-31.69 cm), and it increased to 34.91 cm (95% CI, 33.11-36.72 cm) after the passive leg raise. The Δ VTI values were 1.83% (95% CI, 0.12%-3.55%) in the predialysis group and 15.05% (95% CI, 12.76%-17.34%) in the postdialysis cohort. When stratified by fluid removal, the mean Δ VTI values after hemodialysis were 12.64% (95% CI, 9.79%-15.49%) and 16.84% (95% CI, 13.47%-20.22%) for patients who had less than 4 L and 4 L or greater removed, respectively. In patients without congestive heart failure, the Δ VTI was 15.28% (95% CI, 12.25%-18.32%), whereas for those with congestive heart failure, the mean change was 14.63% (95% CI, 10.91%-18.35%). CONCLUSIONS: The LVOT VTI in conjunction with a passive leg raise seems to correlate with the volume status and volume responsiveness.

Use of Contrast-Enhanced Ultrasound for Confirmation of Central Venous Catheter Placement: Systematic Review and Meta-analysis.

OBJECTIVES: The purpose of this meta-analysis was to determine the sensitivity, specificity, and positive and negative predictive values of contrast-enhanced ultrasound (US) for confirming the tip location and placement of central venous catheters in adult patients. METHODS: A systematic review was performed using electronic databases, including MEDLINE, ClinicalTrials.gov, Cochrane, Embase, PubMed, and Scopus. Inclusion criteria were studies conducted on adult patients receiving an internal jugular or a subclavian central venous catheter in the emergency department or intensive care unit. Furthermore, the catheter tip location had to be checked with the use of the agitated saline contrast-enhanced US technique. RESULTS: A total of 2245 articles were screened by title and abstract. Seventeen articles were retrieved and assessed for the predefined inclusion criteria. Four articles and 1 abstract were used in the final analysis. Contrast-enhanced US showed pooled sensitivity of 72% (95% confidence interval, 44%-91%), pooled specificity of 100% (95% confidence interval, 99%-100%), a positive predictive value of 92.1%, and a negative predictive value of 98.5% compared with chest radiography for confirming the placement of central venous catheters. CONCLUSIONS: In the setting of central venous catheter placement, postprocedural contrast-enhanced US imaging is a safe, efficient, and highly specific confirmatory test for the catheter tip location compared with chest radiography.