title: Measuring aortic diameter improves accuracy of esophageal Doppler in assessing fluid responsiveness.
abstract: OBJECTIVE
  Fluid responsiveness requires the accurate measurement of cardiac output that can be approached by aortic blood flow (ABF) as measured by esophageal Doppler monitoring (EDM). EDM devices may either include an echo-determination of aortic diameter or estimate aortic diameter from nomograms and thus consider it as constant. However, it is unclear if measuring aortic diameter increases the accuracy of EDM to identify fluid responsiveness. Aortic diameter varies with arterial pressure such that its measure could be essential for assessing the changes in ABF during acute circulatory failure. We attempted to demonstrate that measuring aortic diameter improved the accuracy of EDM to assess fluid responsiveness.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  University hospital intensive care unit.
  
  
  METHODS
  Seventy-six patients with acute circulatory failure in whom a fluid challenge was given.
  
  
  METHODS
  Rapid volume expansion (500 mL of NaCl 0.9%).
  
  
  RESULTS
  We measured aortic velocity and area by EDM before and after fluid loading and evaluated the effects of fluid challenge on ABF, either measured after fluid infusion (measured ABFafter) or estimated assuming an unchanging aortic area (estimated ABFafter). If measured ABFafter was used for assessing fluid response, it was increased above 15% compared with ABF at baseline in 41 patients (responders). Conversely, estimated ABFafter increased above 15% from ABF at baseline in 27 patients only; that is, the effects of the challenge were underestimated in 14 patients. In these 14 patients, the relative change in mean arterial pressure during volume expansion was of greater magnitude than in patients who were classified as nonresponders by considering measured ABFafter.
  
  
  CONCLUSIONS
  Monitoring the changes in aortic diameter improves the accuracy of EDM in assessing the hemodynamic effects of a fluid challenge, especially if it induces a large increase in arterial pressure. Estimating rather than measuring the aortic diameter may lead to underestimation of fluid responsiveness.
authors.affiliation: Service de réanimation médicale, Equipe d'accueil 4046, Centre Hospitalier Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris, Equipe d'accueil 4046, Université Paris 11, Le Kremlin-Bicêtre, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Monnet
authors.forename: Denis
authors.initials: D
authors.lastname: Chemla
authors.forename: David
authors.initials: D
authors.lastname: Osman
authors.forename: Nadia
authors.initials: N
authors.lastname: Anguel
authors.forename: Christian
authors.initials: C
authors.lastname: Richard
authors.forename: Michael R
authors.initials: MR
authors.lastname: Pinsky
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Teboul
mesh_terms: D001013:Aorta, Thoracic / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000502:physiology*; D004947:Esophagus; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes; D011446:Prospective Studies; D012039:Regional Blood Flow; D015203:Reproducibility of Results; D018608:Ultrasonography, Doppler / Q000379:methods*
chemical_list: D010952:Plasma Substitutes