title: Respiratory variation in carotid peak systolic velocity predicts volume responsiveness in mechanically ventilated patients with septic shock: a prospective cohort study.
abstract: BACKGROUND
  The evaluation of fluid responsiveness in patients with hemodynamic instability remains to be challenging. This investigation aimed to determine whether respiratory variation in carotid Doppler peak velocity (ΔCDPV) predicts fluid responsiveness in patients with septic shock and lung protective mechanical ventilation with a tidal volume of 6 ml/kg.
  
  
  METHODS
  We performed a prospective cohort study at an intensive care unit, studying the effect of 59 fluid challenges on 19 mechanically ventilated patients with septic shock. Pre-fluid challenge ΔCDPV and other static or dynamic measurements were obtained. Fluid challenge responders were defined as patients whose stroke volume index increased more than 15 % on transpulmonary thermodilution. The area under the receiver operating characteristic curve (AUROC) was compared for each predictive parameter.
  
  
  RESULTS
  Fluid responsiveness rate was 51 %. The ΔCDPV had an AUROC of 0.88 (95 % confidence interval (CI) 0.77-0.95); followed by stroke volume variation (0.72, 95 % CI 0.63-0.88), passive leg raising (0.69, 95 % CI 0.56-0.80), and pulse pressure variation (0.63, 95 % CI 0.49-0.75). The ΔCDPV was a statistically significant superior predictor when compared with the other parameters. Sensitivity, specificity, and positive and negative predictive values were also the highest for ΔCDPV, with an optimal cutoff at 14 %. There was good correlation between ΔCDPV and SVI increment after the fluid challenge (r = 0.84; p < 0.001).
  
  
  CONCLUSIONS
  ΔCDPV can be more accurate than other methods for assessing fluid responsiveness in patients with septic shock receiving lung protective mechanical ventilation. ΔCDPV also has a high correlation with SVI increase after fluid challenge.
authors.affiliation: Intensive Care Unit, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Hospital 278, El Retiro, Specialties Building, Floor 1, Guadalajara, Jalisco, 44280, Mexico, drmiguelibarra@hotmail.com.
authors.forename: Miguel Á
authors.initials: MÁ
authors.lastname: Ibarra-Estrada
authors.forename: José A
authors.initials: JA
authors.lastname: López-Pulgarín
authors.forename: Julio C
authors.initials: JC
authors.lastname: Mijangos-Méndez
authors.forename: José L
authors.initials: JL
authors.lastname: Díaz-Gómez
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Aguirre-Avalos