Doppler Ultrasonographic Evaluation of Hepatic Blood Flow Changes in Determination of Fluid Responsiveness in Critically Ill Patients With Sepsis: A Chance for a Novel Indicator?

Abstract

Abstract Purpose Fluid resuscitation is important in the management of hemodynamically unstable patients. Prediction of fluid responsiveness among septic critically ill patients can aid in monitoring patients and predicting their mortality. This study aimed to assess the potential hepatic hemodynamic response in response to intravenous fluids administration in sepsis by examining whether there are any alterations in hepatic blood flow values and whether these alterations can guide intravenous fluid resuscitation. Patients and methods Thirty patients who were admitted to the intensive care unit with sepsis were enrolled in this study. They were older than 18 years excluding the following criteria: Preexisting liver disease, positive pressure ventilation (invasive or noninvasive), acute myocardial infarction, heart failure (valvular or structural), persistent arrhythmia, chronic renal disease, and high abdominal pressure. Patients were divided according to the alterations in left ventricular stroke volume in response to intravenous fluids administration into 2 main groups, such as responders and nonresponders. We compared between both groups regarding clinical, laboratory, and ultrasound findings. Results Thirty patients were included in this study. Seventeen patients were responsive to intravenous fluids administration, whereas 13 were nonresponsive. After the administration of intravenous fluids, stroke volume, cardiac output, and mean arterial pressure (MAP) were significantly higher in the responders when compared with the nonresponders. However, the heart rate and central venous pressure (CVP) were significantly lower in the responders when compared with the nonresponders. The % changes in each stroke volume, cardiac output, MAP, hepatic artery volume flow, total hepatic volume flow, and portal vein volume flow were significantly more in the responders than in the nonresponders. However, the % changes in CVP were significantly lower among patients in the responders group when compared with the nonresponders group. Among patients in the responders group, there was a statistically significant increase in postadministration readings of each of stroke volume, cardiac output, portal vein volume flow, hepatic artery volume flow, total hepatic volume flow. There was a statistically significant decrease in postadministration readings of the heart rate when compared with the preadministration readings. Among patients in the nonresponders group, there was a significant in postadministration readings of each of stroke volume, cardiac output, cardiac index, and MAP. However, there was a significant increase in portal vein volume flow, hepatic artery volume flow, and total hepatic volume flow. There was a significant increase in CVP readings when compared with the preadministration readings. Conclusion Each of hepatic artery volume flow % change, total hepatic volume flow % change, and portal vein volume flow % change can be used as predictors for fluid responsiveness among our study population.

Keywords

• Doppler ultrasonography
• Hepatic blood flow
• Fluid responsiveness
• Sepsis