Review Article

Questioning the Role of Carotid Artery Ultrasound in Assessing Fluid Responsiveness in Critical Illness: A Systematic Review and Meta-Analysis

Table 1

Characteristics of the included studies.

Study, yearSettingSamplingSample size (% fluid responders)Patient groupMVFluid challenge contentFluid challenge volumeRef. St. measureRef. St. threshold (%)Carotid measure

Barjaktarevic et al., 2018 [25]ICUConvenience77 (70.1%)Undifferentiated shock59%PLRn/aSV via NICOM™10CFT
Chowhan et al., 2021 [26]ICUConvenience20 (septic shock group)Control, sepsis, and septic shock100%PLRn/aSV via LVOT VTI>15∆CAVTI
Zhang et al., 2021 [27]ICUConvenience60 (50%)Traumatic haemorrhagic shock100%0.9% sodium chloride250 mlCO via LVOT VTI≥15∆CDPV
Abbasi et al., 2020 [28]ICUConvenience112 (50%)Acute circulatory failure within the first 72 hours0%0.9% sodium chloride500 mlNICOM™ CI≥10CBF
Abbasi et al., 2021 [29]ICUConvenience86 (58%)Acute circulatory failure within the first 72 hours0%0.9% sodium chloride500 mlNICOM™ CI≥10∆CDPV
Lu et al., 2017 [30]ICUConvenience49 (55%)Septic shockNS0.9% sodium chloride200 mlCO and CI index via PiCCO™≥10∆CDPV
Marik et al., 2013 [9]ICUNot stated34 (53%)Hemodynamic instability (64.7% with septic shock)56%PLR + 0.9% sodium chloride500 mlSV via NICOM™≥10∆CAVTI
Soliman et al., 2022 [31]ICUNot stated30 (70%)Septic shock100%Crystalloid7 ml/kgCO via LVOT VTI≥15∆CDPV
Jelic et al., 2015 [32]ICUNot stated17 (29%)ShockNSPLRn/aPAC≥10CFT
Effat et al., 2021 [33]ICUNot stated44 (45%)Sepsis ± shock46%PLR + 0.9% saline6 ml/kgLVOT VTI≥15CBF
McGregor et al., 2020 [34]EDConvenience33 (61%)Patients which required an IV fluid bolus0%Crystalloid250–500 mlSV via LVOT VTI≥10CBF
Girotto et al., 2018 [35]ICUNot statedVTI 60 (67%)PiCCO2 device in situ, decision to PLR not stated94%PLR + 0.9% sodium chloride500 mlCardiac index via PiCCO™≥10 on pulse contour∆CAVTI
Ibarra-Estrada et al., 2015 [36]ICUConvenience19 patients 59 fluid challenges (51%)Septic shock100%PLR + crystalloid7 ml/kgPAC≥15∆CDPV
Pace et al., [37]ICUConvenience50 (56%)Hemodynamically unstable100%Crystalloid7 ml/kgSV via aortic VTI≥15∆CAVTI + ∆CDPV
Helmy et al., 2022 [38]ICUNot stated40 (75%)Cardiogenic shock78%PLRn/aCO via LVOT VTI≥10CBF
Jalil et al., 2018 [39]ICUNot stated22 (45%)Patients which require IV fluid bolus82%PLRn/aSV via FloTrac™≥15CFT
D’Arrigo et al., 2023 [40]ICUConsecutive18 patients 44 fluid challenges (43.2%)Septic shock100%Crystalloid500 mlCardiac index via thermodilution>15∆CDPV + CFT

MV = mechanically ventilated, Ref. St. = reference standard, ICU = intensive care unit, ED = emergency department, PLR = passive leg raise, SV = stroke volume, NICOM = noninvasive cardiac output monitor, CFT = carotid flow time, ∆CAVTI = change in carotid artery velocity time integral, LVOT VTI = left ventricular outflow tract velocity time integral, ∆CDPV = change in carotid Doppler peak velocity, CBF = carotid blood flow, CO = cardiac output, PAC = pulmonary artery catheter, PiCCO = pulse contour cardiac output, CI = cardiac index, IV = intravenous.