Carotid Doppler and IVC metrics for volume and mortality assessment in septic shock

Abstract

The utility of carotid artery Doppler flow velocity (CADFV) over mortality is not well known. This study investigated the utility of bedside ultrasound in assessing volume status and predicting mortality in patients with septic shock with CADFV, the inferior vena cava collapse index, and the central venous pressure (CVP). This prospective observational study included adults admitted to the ED with septic shock, defined by hypotension (SBP < 90 mmHg or MAP < 65 mmHg) and evidence of end-organ hypoperfusion. Patient demographics, CVP, CADFV, inferior vena cava (IVC) diameter, inferior vena cava collapsibility index (IVCCI), and outcomes were recorded. Measurements are compared in terms of mortality. The mean age was 67 years, with a 57% mortality rate. ROC analysis revealed that CADFV predicted mortality with a sensitivity of 72% and a specificity of 68% at a cutoff of 50 cm/s. The IVCCI had 93% sensitivity and 85% specificity at a cutoff of 54.5%. The CVP had 61% sensitivity and 71% specificity at a cutoff of 1.5 mm H2O. The mean IVCCI was 59%, and the mean CVP was 2.4 mmH(2)O. The mean IVCCI was 59%, and the mean CVP was 2.4 mmH(2)O. The deceased patients had a mean IVCCI of 63% and a mean CVP of 1.62 mmH(2)O, whereas discharged patients had a mean IVCCI of 55% and a mean CVP of 3.45 mmH(2)O. CADFV, IVCCI, and CVP can be used in evaluating the volume status and predicting mortality in septic shock. These noninvasive measures provide alternatives to invasive methods and facilitate timely intervention in emergency care.