Comparative Study between Corrected Carotid Flow Time, Femoral Arterial Doppler and Aortic Velocity Time Index Assessment in Septic Shock Patients

Abstract Background Septic shock is a serious infectious condition characterized by low blood pressure and multiple organ damage. One of the traditional recommendations is to administer intravenous fluids as the first step to improve blood pressure. However, studies have shown that not every patient benefits from aggressive intravenous hydration. Only about 40% of hypotensive patients with sepsis respond to fluid infusion with improvement in blood pressure and outcomes. Aim of the Work to compare between corrected carotid flow time, femoral artery doppler and aortic VTI in fluid responsiveness assessment in septic shock patients. Patients and Methods This is prospective, cohort study conducted on 45 Septic shock patients assessed to detect aortic VTI, corrected carotid flow time and femoral artery Doppler to assess fluid responsiveness, patients attended to intensive care unit of Ain Shams University Hospitals during the period from January 2021 to January 2022. Results 1-Comparative study between corrected carotid flow time, femoral arterial doppler and aortic velocity time index in fluid responsiveness assessment in septic shock patients not differ significantly among sex, age. The vasopressor support Norepinephrine and Dopamine, MV (mechanical ventilation), APACHE II and SOFA, not show any significant changes between the responder and non-responder group. The WBCs, PCT and CRP not show any significant changes between responder and non-responder groups. The hemodynamic parameters HR T0 (beats/min), HR T1 (beats/min), MAP T0 (mm Hg), MAP T1 (mm Hg), PP T0 (mm Hg) and PP T1 (mm Hg) not show any significant changes between responder and no responder groups. The Trans-thoracic echocardiography parameters cleared that, all parameters of Eco that includes LVEF (30 – 49 %) and > 50 %, CO T0 (L/m), CO T1 (L/m), SV T0 (mL), SV T1 (mL), VTIAo T0 (cm) and VTIAo T1 (cm). not differ significantly among responder and non responder groups (P > 0.05) and this variables. While, the VTIAo (%) differ significantly (P < 0.01) between responder and non-responder group. As its level in responder group was 35.34 ± 3.11 and in non-responder group was 8.14±1.15. Conclusion Femoral Doppler parameters is a good tool to assess hemodynamic response to PRL in septic shock. The increase in VFmax over 8% and VTIF over 11% are accurate tool to distinguish fluid responders (R) from non-responders (NR) so, it could be taken as an alternative approach to TTE in monitoring fluid responsiveness. In patients with early, undifferentiated shock, ΔCAVTI and %ccFT induced by a PLR maneuver was able to predict fluid responsiveness. It compares favorably with %VTIAo by Echocardiography, with an AUC of 0.88 suggesting that it is an alternative to other methods. Its effectiveness is not affected by mechanical ventilation, respiratory rate, or PEEP >5mmH2O.