Abstract
This study was designed to evaluate the hemodynamic effect of norepinephrine (NE) on the peak systolic velocity (PSV), diameter, and blood flow of the common carotid artery (CCA) using the point-of-care ultrasound (POCUS) in patients with septic shock. The study involved patients above 18 years old with septic shock. Arterial monitoring, carotid ultrasonography, and transthoracic echocardiography were performed before NE administration (T0). When the mean arterial pressure exceeded 65 mmHg after NE administration (T1), the measurement was repeated. Twenty-four patients (median age 67 [interquartile range: 54–77] years; 42% female) with septic shock were examined in this study. Before (T0) and after (T1) NE administration, the PSV (mean, standard deviation [SD]) changed from 85.3 (21.1) cm/s to 83.5 (23.5) cm/s (p = 0.417); this change was not significant. However, the diameter and blood flow of the CCA increased significantly from 0.6 (0.09) cm and 0.75 (0.27) L/min to 0.66 (0.09) cm and 0.85 (0.27) L/min, respectively (p < 0.001). The diameter of the left ventricular outflow tract (LVOT) remained unchanged, but the velocity time integral of the LVOT increased significantly from 21.7 (4.39) cm to 23.6 (5.14) cm. There was no significant correlation between changes in blood flow of the CCA and changes in cardiac output (coefficient −0.365, p = 0.079). In conclusion, NE increased the diameter and blood flow of the CCA significantly, without changing the PSV in patients with septic shock.
Highlights
This study was designed to evaluate the hemodynamic effect of norepinephrine (NE) on the peak systolic velocity (PSV), diameter, and blood flow of the common carotid artery (CCA) using the point-of-care ultrasound (POCUS) in patients with septic shock
There was no significant correlation between changes in CCA blood flow measured by POCUS and changes in cardiac output (CO) measured by transthoracic echocardiography (TTE)
Carotid POCUS can be used as a tool to assess the increase of mean arterial pressure (MAP) to NE, but it may not be reliable to use as an alternative CO assessment method compared to echocardiography in patients with septic shock
Summary
This study was designed to evaluate the hemodynamic effect of norepinephrine (NE) on the peak systolic velocity (PSV), diameter, and blood flow of the common carotid artery (CCA) using the point-of-care ultrasound (POCUS) in patients with septic shock. NE increased the diameter and blood flow of the CCA significantly, without changing the PSV in patients with septic shock. The hemodynamic effects of NE on the CCA blood flow in patients with septic shock have not been investigated. The correlation between CCA blood flow changes using the point-of-care ultrasound (POCUS) and CO changes using echocardiography according to NE administration is unclear. The aim of this study was to evaluate the hemodynamic effect of NE on the peak systolic velocity (PSV), diameter, and blood flow of the CCA using the POCUS in patients with septic shock. Investigated whether CCA measurements can be used as a method compared to echocardiography in evaluating the response to NE in patients with septic shock
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