Key result
Carotid ultrasound parameters accurately predict fluid responsiveness with an AUROC exceeding ~0.92.
Why the study?
Fluid management in elderly patients undergoing orthopedic surgery requires precision due to altered organ function, and noninvasive alternatives to invasive stroke volume variation monitoring are needed.
Do noninvasive carotid ultrasound parameters (FTc and ΔVpeak) correlate with stroke volume variation for assessing fluid responsiveness in elderly patients undergoing orthopedic surgery?
Observational (n=50)
No
Do noninvasive carotid ultrasound parameters (FTc and ΔVpeak) correlate with stroke volume variation for assessing fluid responsiveness in elderly patients undergoing orthopedic surgery?
Effect estimate: AUROC 0.934 (FTc) and 0.920 (ΔVpeak)
p-value: p=<0.001
Noninvasive carotid ultrasound parameters (FTc and ΔVpeak) strongly correlate with stroke volume variation and can accurately predict fluid responsiveness in elderly surgical patients.
Should not yet change fluid management in elderly surgical patients; leaves open confirmation of carotid ultrasound utility in randomized trials.
Introduction Elderly patients are particularly vulnerable to perioperative complications, and fluid management in this population requires precision due to altered organ function. Overhydration may lead to heart failure or pulmonary oedema, while under hydration risks tissue hypoperfusion. Stroke volume variation (SVV) is widely used to assess fluid responsiveness, yet requires invasive or costly equipment. This study aimed to correlate noninvasive Doppler-derived parameters-carotid corrected flow time (FTc) and respirophasic variation in carotid artery peak velocity (ΔVpeak)-with SVV in elderly patients undergoing orthopaedic surgery under general anesthesia. A secondary aim was to assess their ability to predict SVV greater than or equal to 13%. Patients and methods A prospective observational study was conducted on 50 elderly patients (≥65 years) undergoing elective orthopaedic surgery under general anesthesia at El Hadara University Hospital from December 2023 to April 2025. SVV was continuously monitored via Cardiometry, and FTc and ΔVpeak were measured using right common carotid ultrasound at three time points: before anesthesia (T0), 5 min after intubation (T1), and 1 minute post-fluid challenge (T2). Patients were categorized as responders (SVV ≥13%) or nonresponders, and measurements were repeated every 30 min until the end of the operation. Results There were no significant demographic or baseline hemodynamic differences between groups. FTc and ΔVpeak significantly differed between responders and nonresponders at T1 and T2 (P < 0.001 and P = 0.008, respectively). FTc less than or equal to 339 ms predicted SVV greater than or equal to 13% with AUROC 0.934, sensitivity 90.48%, and specificity 75.86%. ΔVpeak greater than or equal to 11% showed Area Under the Receiver Operating Characteristic (AUROC) 0.920, sensitivity 95.24%, and specificity 82.76%. Both parameters correlated significantly with SVV intraoperatively (P < 0.001).
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Yakout et al. (2025) conducted an observational in Elective orthopaedic surgery under general anesthesia (n=50). Carotid ultrasound parameters (FTc and ΔVpeak) was evaluated on Prediction of stroke volume variation (SVV) ≥13% (AUROC 0.934 (FTc) and 0.920 (ΔVpeak), p=<0.001). Carotid ultrasound parameters FTc ≤339 ms and ΔVpeak ≥11% accurately predicted stroke volume variation ≥13% with AUROCs of 0.934 and 0.920 (P<0.001).
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