ESICM LIVES 2023
Open accessAbstract
Introduction. Hemodynamic monitoring is of utmost importance when treating critically ill patients, but the currently used techniques are invasive and related with catheter-related complications. Over the last two decades, carotid artery ultrasound (US) was investigated as a non-invasive alternative for hemodynamic monitoring, including cardiac output estimation. Both vessel diameter and blood velocity are needed to compute blood flow in a vessel. Traditionally, carotid flow measurements are performed with the US probe oriented in the long-axis (LA) view [1]. Assuming a circular cross-section of the vessel and a parabolic flow profile, the probe should be properly positioned along the mid-axis to obtain an accurate blood flow estimation. However, obtaining and maintaining this mid-axis parallel view is difficult and literature describes that operator experience may impact the reliability of carotid flow measurements [2]. While the short-axis (SA) view allows for measurement of the true diameter, it does not allow for velocity estimation as the Doppler frequency shift approaches 0 degrees. Another way of assessing the cross-section of the carotid artery is by rotating and tilting (RT) the probe, a view that is easier to visualize and assess for sonographers. Regarding velocity measurements, preliminary research showed that the RT view was more robust to motion and less operator-dependent than the LA view [3]. To our knowledge, there is no literature regarding clinical diameter estimates with the RT view.Objectives. To evaluate the use of the RT view in a clinical setting, and to compare it with the LA and SA views using systolic diameter and spread of systolic diameter estimates per acquisition. The spread of systolic diameter values serves as a measure of robustness.Methods. We performed 30 s US acquisitions of the carotid artery in adult cardiac surgery patients, with a LA, SA, and RT probe orientation. The 30 s US recordings were analyzed to derive a diameter waveform. From this, we computed the systolic diameter values and a measurement of spread (calculated as the IQR of the systolic diameter estimates per acquisition) and investigated for potentially significant differences between views. Results. US acquisitions were performed in 29 patients. The median systolic diameter (IQR) per 30 s acquisition was 7.08 (1.59) mm, 7.22 (1.20) mm, and 6.95 (1.77) mm for the LA, SA, and RT views, respectively (Fig. 1). The median spread (IQR) per 30 s acquisition was 0.12 (0.13) mm, 0.10 (0.10) mm, and 0.09 (0.10) mm for the LA, SA, and RT views, respectively. Normality was checked using the Shapiro–Wilk test and Friedman tests showed no statistically significant difference between the views for either the median (p=0.142) or spread (p=0.786) of systolic diameter per 30 s acquisition. Conclusions. It was feasible to acquire data and derive diameter estimates using the three probe orientations. The median and spread in systolic diameter values per 30 s acquisition were comparable for the LA, SA, and RT views, suggesting that the different views result in evenly robust measurements and can be used interchangeably to obtain diameter estimates. This study opens the path for further investigation of the newly introduced RT view for new applications and possibilities, such as hands-free measurements.
AI snapshot
Written from the paper’s full text.
TL;DR
In adult cardiac surgery patients, carotid artery ultrasound diameter estimates obtained with long-axis (LA), short-axis (SA), and rotated-and-tilted (RT) probe orientations were comparable, suggesting the three views yield evenly robust measurements and can be used interchangeably. The RT view is proposed as an easier-to-acquire alternative that may enable new applications such as hands-free measurements.
Key findings
- Median systolic diameter (IQR) per 30 s acquisition was 7.08 (1.59) mm for LA, 7.22 (1.20) mm for SA, and 6.95 (1.77) mm for RT.
- Median spread (IQR) per 30 s acquisition was 0.12 (0.13) mm for LA, 0.10 (0.10) mm for SA, and 0.09 (0.10) mm for RT.
- Friedman tests showed no statistically significant difference between views for either the median (p = 0.142) or the spread (p = 0.786) of systolic diameter per 30 s acquisition.
- It was feasible to acquire data and derive diameter estimates using all three probe orientations.
Methods
- Design: comparative study of carotid artery ultrasound acquisitions in three probe orientations (LA, SA, RT), each 30 s, in adult cardiac surgery patients.
- Sample: US acquisitions were performed in 29 patients.
- Analysis: 30 s recordings were processed to derive a diameter waveform; systolic diameter values and a spread measure (IQR of systolic diameter estimates per acquisition) were computed. Normality was checked with the Shapiro-Wilk test and differences between views were tested with Friedman tests.
Limitations
- Stated: the paper does not explicitly list limitations; it frames the work as opening "the path for further investigation" of the RT view.
- Evident from the text: the sample is small (29 patients) and drawn from a single clinical setting (adult cardiac surgery in the operating room), and the study evaluates only diameter estimates, not velocity or blood-flow/cardiac-output estimation, so interchangeability for flow measurement is not established.
Model-written summary. Check it against the paper before relying on it.
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Cites
Statistics
Claims the paper makes
2 of 3 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured
- Premisecitation§ 000334 · p. 3
Operator experience may impact the reliability of carotid flow measurements.
“obtaining and maintaining this mid-axis parallel view is difficult and literature describes that operator experience may impact the reliability of carotid flow measurements [2].”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [2] [2] R. Osgood, In training emergency physicians the carotid artery Doppler with passive leg raise, does previous sonographic experience influence scan time and competency?, Australasian Society for Ultrasound in Medicine, vol. 24, no. 1, pp. 20-26, 2020. - 3) source
The Reliability Parameter section (page unavailable) says differences in participants’ prior scanning experience may have altered their performance. But it also states that the study did not assess the reliability of their measurements against a gold standard; the Discussion reports no correlation between prior experience and scan quality. The paper therefore supports a possible effect on performance, not the claimed effect on measurement reliability. (LLM, conf=0.78)
Experimental — accuracy not yet measured
- Findingown data§ 000335 · p. 3
Multidrug-resistant (MR) Pseudomonas was significantly higher in patients who died.
“Multidrug-resistant (MR) Pseudomonas and MR Gram-negative bacteria (GNB) were significantly higher in patients who died (Table 1).”
- Also stated in: § 000335 · p. 3 · plain
“Pseudomonas MRs and GNB MRs also had significantly higher mortality.”
Quote in the paperSubstantial claim - Also stated in: § 000335 · p. 3 · plain
- Findingown data§ 000334 · p. 3
The median systolic diameter per 30 s acquisition was 6.95 (IQR 1.77) mm for the RT view.
“The median systolic diameter (IQR) per 30 s acquisition was 7.08 (1.59) mm, 7.22 (1.20) mm, and 6.95 (1.77) mm for the LA, SA, and RT views, respectively (Fig. 1).”
Quote in the paperSubstantial claim - Findingown data§ Take down policy · p. 2
There were no statistically significant differences between the SDD and non-SDD groups in admission type or demographics.
“There were no statistically significant differences between the two groups in terms of admission type or demographics.”
Quote in the paperNot a substantial claim - Findingown data§ 000335 · p. 3
Neoplasm was an independent mortality risk factor (OR 2.567, 95% CI 1.532-4.304).
“Independent mortality risk factors were: renal replacement therapy Odds Ratio (OR): 4.662 (3.373; 6.444), neoplasm OR: 2.567 (1.532; 4.304), ventilator-associated pneumonia (VAP):OR: 1.980 (1.407; 2. 787), parenteral nutrition OR: 1.927 (1.322; 2.809), chronic obstructive pulmonary disease (COPD) OR:1. 852 (1.223; 2.805), septic shock OR: 1.817 (1.307; 2.527) and APACHE II OR:1.054 (1.031; 1.077).”
Quote in the paperSubstantial claim
- Findingown data§ Take down policy · p. 2
Tobramycin-resistant colonization was 27.8% of samples.
“Colistin-resistant colonization was 18.9% and tobramycinresistant colonization was 27.8% of samples.”
Quote in the paperSubstantial claim - Findingown data§ 000334 · p. 3
The median spread per 30 s acquisition was 0.10 (IQR 0.10) mm for the SA view.
“The median spread (IQR) per 30 s acquisition was 0.12 (0.13) mm, 0.10 (0.10) mm, and 0.09 (0.10) mm for the LA, SA, and RT views, respectively.”
Quote in the paperNot a substantial claim - Findingown data§ Take down policy · p. 2
SDD patients had significantly fewer Acinetobacter spp. infections than non-SDD patients (p<0.001).
“SDD patients had significantly fewer Extended Spectrum Betalactamase (ESBL) infections p = 0.015, Gram Negative Multidrug Resistant Bacteria (GNB-MR) p = 0.002 and Acinetobacter spp . infections p < 0.001.”
- Also stated in: § Take down policy · p. 2 · plain
“After eleven years of SDD implementation, a significant reduction in ESBL, GNB-MR and Acinetobacter infections was persistently observed.”
Quote in the paperSubstantial claim - Also stated in: § Take down policy · p. 2 · plain
- Findingown data§ Take down policy · p. 2
The rate of urinary tract infections per 1000 days of catheter was significantly lower in the SDD group than in the non-SDD group (3.79 vs 2.43, p=0.017, RR 0.642, 95% CI 0.446-0.923).
“Urinary infections | Infections/1000 days of catheter | 3.79 | 2.43 | 0.017 | 0.642 (0.446 - 0.923)”
- Also stated in: § Take down policy · p. 2 · plain
“There was also a significant reduction in the rates of ventilator-associated pneumonia (VAP), urinary tract infections, other secondary bacteremia and multidrug-resistant bacteria infections (MR-GNB) in the SDD group versus the non-SDD group.”
Quote in the paperSubstantial claim - Also stated in: § Take down policy · p. 2 · plain
- Findingnone given§ 000334 · p. 3
It was feasible to acquire data and derive diameter estimates using the three probe orientations.
“It was feasible to acquire data and derive diameter estimates using the three probe orientations.”
Quote in the paperSubstantial claim - Findingown data§ Take down policy · p. 2
Colistin-resistant colonization was 18.9% of samples.
“Colistin-resistant colonization was 18.9% and tobramycinresistant colonization was 27.8% of samples.”
Quote in the paperSubstantial claim - Findingown data§ Take down policy · p. 2
There was no Clostridium difficile infection.
“There was no Clostridium difficile infection.”
Quote in the paperNot a substantial claim - Findingown data§ 000335 · p. 3
Renal replacement therapy was an independent mortality risk factor (OR 4.662, 95% CI 3.373-6.444).
“Independent mortality risk factors were: renal replacement therapy Odds Ratio (OR): 4.662 (3.373; 6.444), neoplasm OR: 2.567 (1.532; 4.304), ventilator-associated pneumonia (VAP):OR: 1.980 (1.407; 2. 787), parenteral nutrition OR: 1.927 (1.322; 2.809), chronic obstructive pulmonary disease (COPD) OR:1. 852 (1.223; 2.805), septic shock OR: 1.817 (1.307; 2.527) and APACHE II OR:1.054 (1.031; 1.077).”
Quote in the paperSubstantial claim - Findingown data§ 000334 · p. 3
The median and spread in systolic diameter values per 30 s acquisition were comparable for the LA, SA, and RT views.
“The median and spread in systolic diameter values per 30 s acquisition were comparable for the LA, SA, and RT views, suggesting that the different views result in evenly robust measurements and can be used interchangeably to obtain diameter estimates.”
Quote in the paperSubstantial claim - Findingown data§ 000335 · p. 3
Of the 12,016 patients admitted, 313 (35.16%) of the 890 patients with NI died.
“Of the 12,016 patients admitted, 313 (35.16%) of the 890 patients with NI died.”
Quote in the paperNot a substantial claim - Findingown data§ 000334 · p. 3
Friedman tests showed no statistically significant difference between the LA, SA, and RT views for the spread of systolic diameter per 30 s acquisition (p=0.786).
“Normality was checked using the Shapiro-Wilk test and Friedman tests showed no statistically significant difference between the views for either the median (p = 0.142) or spread (p = 0.786) of systolic diameter per 30 s acquisition.”
Quote in the paperSubstantial claim - Findingown data§ 000334 · p. 3
The median spread per 30 s acquisition was 0.09 (IQR 0.10) mm for the RT view.
“The median spread (IQR) per 30 s acquisition was 0.12 (0.13) mm, 0.10 (0.10) mm, and 0.09 (0.10) mm for the LA, SA, and RT views, respectively.”
Quote in the paperSubstantial claim - Findingown data§ 000334 · p. 3
The median systolic diameter per 30 s acquisition was 7.22 (IQR 1.20) mm for the SA view.
“The median systolic diameter (IQR) per 30 s acquisition was 7.08 (1.59) mm, 7.22 (1.20) mm, and 6.95 (1.77) mm for the LA, SA, and RT views, respectively (Fig. 1).”
Quote in the paperNot a substantial claim - Findingown data§ Take down policy · p. 2
SDD patients had significantly fewer ESBL infections than non-SDD patients (p=0.015).
“SDD patients had significantly fewer Extended Spectrum Betalactamase (ESBL) infections p = 0.015, Gram Negative Multidrug Resistant Bacteria (GNB-MR) p = 0.002 and Acinetobacter spp . infections p < 0.001.”
- Also stated in: § Take down policy · p. 2 · plain
“After eleven years of SDD implementation, a significant reduction in ESBL, GNB-MR and Acinetobacter infections was persistently observed.”
Quote in the paperSubstantial claim - Also stated in: § Take down policy · p. 2 · plain
- Findingown data§ 000334 · p. 3
The median systolic diameter per 30 s acquisition was 7.08 (IQR 1.59) mm for the LA view.
“The median systolic diameter (IQR) per 30 s acquisition was 7.08 (1.59) mm, 7.22 (1.20) mm, and 6.95 (1.77) mm for the LA, SA, and RT views, respectively (Fig. 1).”
Quote in the paperSubstantial claim - Findingown data§ 000334 · p. 3
Friedman tests showed no statistically significant difference between the LA, SA, and RT views for the median systolic diameter per 30 s acquisition (p=0.142).
“Normality was checked using the Shapiro-Wilk test and Friedman tests showed no statistically significant difference between the views for either the median (p = 0.142) or spread (p = 0.786) of systolic diameter per 30 s acquisition.”
Quote in the paperSubstantial claim - Findingown data§ 000335 · p. 3
APACHE II was an independent mortality risk factor (OR 1.054, 95% CI 1.031-1.077).
“Independent mortality risk factors were: renal replacement therapy Odds Ratio (OR): 4.662 (3.373; 6.444), neoplasm OR: 2.567 (1.532; 4.304), ventilator-associated pneumonia (VAP):OR: 1.980 (1.407; 2. 787), parenteral nutrition OR: 1.927 (1.322; 2.809), chronic obstructive pulmonary disease (COPD) OR:1. 852 (1.223; 2.805), septic shock OR: 1.817 (1.307; 2.527) and APACHE II OR:1.054 (1.031; 1.077).”
Quote in the paperSubstantial claim - Findingown data§ 000335 · p. 3
Chronic obstructive pulmonary disease (COPD) was an independent mortality risk factor (OR 1.852, 95% CI 1.223-2.805).
“Independent mortality risk factors were: renal replacement therapy Odds Ratio (OR): 4.662 (3.373; 6.444), neoplasm OR: 2.567 (1.532; 4.304), ventilator-associated pneumonia (VAP):OR: 1.980 (1.407; 2. 787), parenteral nutrition OR: 1.927 (1.322; 2.809), chronic obstructive pulmonary disease (COPD) OR:1. 852 (1.223; 2.805), septic shock OR: 1.817 (1.307; 2.527) and APACHE II OR:1.054 (1.031; 1.077).”
Quote in the paperSubstantial claim - Findingown data§ 000334 · p. 3
The median spread per 30 s acquisition was 0.12 (IQR 0.13) mm for the LA view.
“The median spread (IQR) per 30 s acquisition was 0.12 (0.13) mm, 0.10 (0.10) mm, and 0.09 (0.10) mm for the LA, SA, and RT views, respectively.”
Quote in the paperSubstantial claim - Findingown data§ 000335 · p. 3
Multidrug-resistant (MR) Gram-negative bacteria (GNB) were significantly higher in patients who died.
“Multidrug-resistant (MR) Pseudomonas and MR Gram-negative bacteria (GNB) were significantly higher in patients who died (Table 1).”
- Also stated in: § 000335 · p. 3 · plain
“Pseudomonas MRs and GNB MRs also had significantly higher mortality.”
Quote in the paperNot a substantial claim - Also stated in: § 000335 · p. 3 · plain
- Findingown data§ Take down policy · p. 2
There was a decrease in DDD/100 ICU stays after SDD.
“There was a decrease in DDD/100 ICU stays after SDD.”
- Also stated in: § Take down policy · p. 2 · plain
“A reduction in antibiotic consumption was observed after SDD.”
Quote in the paperSubstantial claim - Also stated in: § Take down policy · p. 2 · plain
- Findingown data§ Take down policy · p. 2
SDD patients had significantly fewer GNB-MR infections than non-SDD patients (p=0.002).
“SDD patients had significantly fewer Extended Spectrum Betalactamase (ESBL) infections p = 0.015, Gram Negative Multidrug Resistant Bacteria (GNB-MR) p = 0.002 and Acinetobacter spp . infections p < 0.001.”
- Also stated in: § Take down policy · p. 2 · plain
“After eleven years of SDD implementation, a significant reduction in ESBL, GNB-MR and Acinetobacter infections was persistently observed.”
Quote in the paperSubstantial claim - Also stated in: § Take down policy · p. 2 · plain
- Findingown data§ 000335 · p. 3
Septic shock was an independent mortality risk factor (OR 1.817, 95% CI 1.307-2.527).
“Independent mortality risk factors were: renal replacement therapy Odds Ratio (OR): 4.662 (3.373; 6.444), neoplasm OR: 2.567 (1.532; 4.304), ventilator-associated pneumonia (VAP):OR: 1.980 (1.407; 2. 787), parenteral nutrition OR: 1.927 (1.322; 2.809), chronic obstructive pulmonary disease (COPD) OR:1. 852 (1.223; 2.805), septic shock OR: 1.817 (1.307; 2.527) and APACHE II OR:1.054 (1.031; 1.077).”
Quote in the paperSubstantial claim - Findingown data§ Take down policy · p. 2
The rate of secondary bacteremia per 1000 ICU days was significantly lower in the SDD group than in the non-SDD group (4.69 vs 2.10, p<0.001, RR 0.488, 95% CI 0.323-0.620).
“Secondary bacteremia | Bacteremia./1000 ICU days | 4.69 | 2.10 | <0.001 | 0.488 (0.323 - 0.620)”
- Also stated in: § Take down policy · p. 2 · plain
“There was also a significant reduction in the rates of ventilator-associated pneumonia (VAP), urinary tract infections, other secondary bacteremia and multidrug-resistant bacteria infections (MR-GNB) in the SDD group versus the non-SDD group.”
Quote in the paperSubstantial claim - Also stated in: § Take down policy · p. 2 · plain
- Findingown data§ Take down policy · p. 2
The rate of multidrug-resistant bacteria infections per 1000 ICU days was significantly lower in the SDD group than in the non-SDD group (9.59 vs 2.76, p<0.001, RR 0.288, 95% CI 0.227-0.365).
“Multiresistant germs | Multiresistant germs/1000 ICU days | 9.59 | 2.76 | <0.001 | 0.288 (0.227 - 0.365)”
- Also stated in: § Take down policy · p. 2 · plain
“There was also a significant reduction in the rates of ventilator-associated pneumonia (VAP), urinary tract infections, other secondary bacteremia and multidrug-resistant bacteria infections (MR-GNB) in the SDD group versus the non-SDD group.”
Quote in the paperSubstantial claim - Also stated in: § Take down policy · p. 2 · plain
- Findingown data§ 000335 · p. 3
In a univariate analysis, no statistically significant differences in ICU stay were found.
“In a univariate analysis, no statistically significant differences in ICU stay were found.”
Quote in the paperNot a substantial claim - Findingown data§ 000335 · p. 3
Ventilator-associated pneumonia (VAP) was an independent mortality risk factor (OR 1.980, 95% CI 1.407-2.787).
“Independent mortality risk factors were: renal replacement therapy Odds Ratio (OR): 4.662 (3.373; 6.444), neoplasm OR: 2.567 (1.532; 4.304), ventilator-associated pneumonia (VAP):OR: 1.980 (1.407; 2. 787), parenteral nutrition OR: 1.927 (1.322; 2.809), chronic obstructive pulmonary disease (COPD) OR:1. 852 (1.223; 2.805), septic shock OR: 1.817 (1.307; 2.527) and APACHE II OR:1.054 (1.031; 1.077).”
Quote in the paperSubstantial claim - Findingown data§ Take down policy · p. 2
The rate of VAP per 1000 days of mechanical ventilation was significantly lower in the SDD group than in the non-SDD group (10.31 vs 3.88, p<0.001, RR 0.376).
“VAP/ MV | VAP/1000 days of MV | 10.31 | 3.88 | <0.001 | 0.376”
- Also stated in: § Take down policy · p. 2 · plain
“There was also a significant reduction in the rates of ventilator-associated pneumonia (VAP), urinary tract infections, other secondary bacteremia and multidrug-resistant bacteria infections (MR-GNB) in the SDD group versus the non-SDD group.”
Quote in the paperSubstantial claim - Also stated in: § Take down policy · p. 2 · plain
- Findingown data§ 000335 · p. 3
Parenteral nutrition was an independent mortality risk factor (OR 1.927, 95% CI 1.322-2.809).
“Independent mortality risk factors were: renal replacement therapy Odds Ratio (OR): 4.662 (3.373; 6.444), neoplasm OR: 2.567 (1.532; 4.304), ventilator-associated pneumonia (VAP):OR: 1.980 (1.407; 2. 787), parenteral nutrition OR: 1.927 (1.322; 2.809), chronic obstructive pulmonary disease (COPD) OR:1. 852 (1.223; 2.805), septic shock OR: 1.817 (1.307; 2.527) and APACHE II OR:1.054 (1.031; 1.077).”
Quote in the paperSubstantial claim - Interpretationown data§ 000334 · p. 3
The different views result in evenly robust measurements.
“The median and spread in systolic diameter values per 30 s acquisition were comparable for the LA, SA, and RT views, suggesting that the different views result in evenly robust measurements and can be used interchangeably to obtain diameter estimates.”
Quote in the paperSubstantial claim - Premisereasoning§ 000334 · p. 3
The short-axis (SA) view does not allow for velocity estimation as the Doppler frequency shift approaches 0 degrees.
“While the short-axis (SA) view allows for measurement of the true diameter, it does not allow for velocity estimation as the Doppler frequency shift approaches 0 degrees.”
Quote in the paperSubstantial claim - Interpretationown data§ 000334 · p. 3
The different views can be used interchangeably to obtain diameter estimates.
“The median and spread in systolic diameter values per 30 s acquisition were comparable for the LA, SA, and RT views, suggesting that the different views result in evenly robust measurements and can be used interchangeably to obtain diameter estimates.”
Quote in the paperSubstantial claim
- Classified as probably not a substantial claim. 3
- May combine two claims. 1
Classified as probably not a substantial claim.
Premisecitation§ 000334 · p. 3Traditionally, carotid flow measurements are performed with the US probe oriented in the long-axis (LA) view.
“Traditionally, carotid flow measurements are performed with the US probe oriented in the longaxis (LA) view [1].”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [1] [1] W. Lee, General principles of carotid Doppler ultrasonography, Ultrasonography, vol. 33, no. 1, pp. 11-17, 2014. - 2) source
Classified as probably not a substantial claim. May combine two claims.
Premisecitation§ 000334 · p. 3Preliminary research showed that the RT view was more robust to motion and less operator-dependent than the LA view.
“Regarding velocity measurements, preliminary research showed that the RT view was more robust to motion and less operator-dependent than the LA view [3].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [3] [3] L. van Knippenberg, An angle-independent cross-sectional Doppler method for flow estimation in the common carotid artery, IEEE Transactions on Ultrasonics, Ferroelectrics, and Frequency Control, vol. 67, no. 8, pp. 1513-1524, 2020. - 4) This work was supported by the Dutch Research Council (NWO) [grant number 17878]. Topic: Cardiovascular issues in ICU. source
Classified as probably not a substantial claim.
Study design and conductown data§ 000334 · p. 3Normality was checked using the Shapiro-Wilk test.
“Normality was checked using the Shapiro-Wilk test and Friedman tests showed no statistically significant difference between the views for either the median (p = 0.142) or spread (p = 0.786) of systolic diameter per 30 s acquisition.”
Quote in the paperSubstantial claim
The authors state this as an assumption.
The carotid artery has a circular cross-section and a parabolic flow profile.
“Assuming a circular cross-section of the vessel and a parabolic flow profile, the probe should be properly positioned along the mid-axis to obtain an accurate blood flow estimation.”
The paper relies on this without support.
Both vessel diameter and blood velocity are needed to compute blood flow in a vessel.
“Both vessel diameter and blood velocity are needed to compute blood flow in a vessel.”
The paper relies on this without support.
Obtaining and maintaining the mid-axis parallel view is difficult.
“However, obtaining and maintaining this mid-axis parallel view is difficult and literature describes that operator experience may impact the reliability of carotid flow measurements [2].”
The paper relies on this without support.
The short-axis view allows for measurement of the true diameter.
“While the short-axis (SA) view allows for measurement of the true diameter, it does not allow for velocity estimation as the Doppler frequency shift approaches 0 degrees.”
The paper relies on this without support.
The rotating and tilting view is easier to visualize and assess for sonographers.
“Another way of assessing the cross-section of the carotid artery is by rotating and tilting (RT) the probe, a view that is easier to visualize and assess for sonographers.”
The paper relies on this without support.
There is no literature regarding clinical diameter estimates with the RT view.
“To our knowledge, there is no literature regarding clinical diameter estimates with the RT view.”
The paper relies on this without support.
Selective digestive decontamination has been associated with reduced ICU mortality and acquired infection rates.
“Selective digestive decontamination (SDD) has been associated with a reducution in mortality and ICU-acquired infection (NI) rates”
“Selective digestive decontamination (SDD) has been associated with reduced ICU mortality and acquired infection rates.”
The paper relies on this without support.
Recognition of risk factors for mortality and early intervention with appropriate administration of broad-spectrum antimicrobials in patients with NI can significantly improve outcomes.
“Recognition of risk factors for mortality and early intervention with appropriate administration of broad-spectrum antimicrobials in patients with nosocomial infection (NI) can significantly improve outcomes.”
The paper relies on this without support.
Currently used hemodynamic monitoring techniques are invasive and related with catheter-related complications.
“Hemodynamic monitoring is of utmost importance when treating critically ill patients, but the currently used techniques are invasive and related with catheter-related complications.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Scheduled-surgery percentage does not match the SDD group size
MinorTable 1 reports 91 scheduled-surgery admissions among 780 SDD patients, or 11.7%, rather than 13.6%.
Reported 13.6 · recomputed 11.666667
“| Scheduled surgery | 10 (9.1) | 91 (13.6) | |”
SDD admission categories do not total the stated group size
MinorThe three admission-category counts in Table 1 add to 765, although its SDD column is labeled N=780; no missing-admission category is shown.
Reported 780 · recomputed 765
“| Medical | 79 (71.8) | 564 (72,3) | | | Scheduled surgery | 10 (9.1) | 91 (13.6) | | | Emergency surgery | 21 (19.1) | 110 (14.1) | |”
Cites
General principles of carotid Doppler ultrasonography
Lee, W. (2013) · Ultrasonography · doi:10.14366/usg.13018 · Cited by 134 · see citing works
An Angle-Independent Cross-Sectional Doppler Method for Flow Estimation in the Common Carotid Artery
van Knippenberg, L., van Sloun, R. J. G., Shulepov, S., Bouwman, R. A., & Mischi, M. (2020) · IEEE Transactions on Ultrasonics, Ferroelectrics, and Frequency Control · doi:10.1109/tuffc.2020.2975315 · Cited by 11 · see citing works
Osgood, R., Mohan, S., John, L., Stirling, E., & Stirling, S. (2021) · Australasian Journal of Ultrasound in Medicine · doi:10.1002/ajum.12204 · Cited by 8 · see citing works
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Cited by
Sorted by citations
Retter, A., Singer, M., & Annane, D. (2025) · Critical Care · doi:10.1186/s13054-025-05283-0 · Cited by 106 · see citing works
Transcranial ultrasound in the critically ill patient: a narrative review
Cashmore, R., & Czosnyka, M. (2025) · Intensive Care Medicine Experimental · doi:10.1186/s40635-025-00787-z · Cited by 3 · see citing works
Ergezen, S., Ewoldt, T. M. J., van der Jagt, M., et al. (2024) · Intensive Care Medicine · doi:10.1007/s00134-024-07459-8 · Cited by 2 · see citing works
Chaudhary, R. K., Dhir, A., Ganesh, V., et al. (2025) · European Journal of Trauma and Emergency Surgery · doi:10.1007/s00068-024-02751-0 · Cited by 2 · see citing works
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Publisher Correction: ESICM LIVES 2023
(2023) · Intensive Care Medicine Experimental · doi:10.1186/s40635-023-00575-7
(2023) · Reactions Weekly · doi:10.1007/s40278-023-52088-4
(2023) · Reactions Weekly · doi:10.1007/s40278-023-52139-7
(2023) · Reactions Weekly · doi:10.1007/s40278-023-52086-4
Prothrombin-complex-concentrate
(2024) · Reactions Weekly · doi:10.1007/s40278-024-56552-6
(2024) · Reactions Weekly · doi:10.1007/s40278-024-56361-9
Mythos „Volumenmangel bei Sepsis“
Markus, M., Fabig, L., Skrypnikov, V., et al. (2025) · AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie · doi:10.1055/a-2254-3340
Islamagič, L., Djebbara, I., Nielsen, T. H., et al. (2026) · Neurocritical Care · doi:10.1007/s12028-026-02461-y
Progress in lung ultrasound education: An updated systematic review
Borggaard, P. G., Kildegaard, C., Laursen, C. B., Bhatnagar, R., Volpicelli, G., & Pietersen, P. I. (2026) · The Ultrasound Journal · doi:10.5826/tuj.2026.18361 · Cited by 1 · see citing works
- Authors
- Pastore, G., Graziano, F., Robba, C., Sivero, M., Mulazzani, F., Noè, B., Consonni, M., Colombo, E., Abate, M., Savo, D., Quaranta, C., & Citerio, G.
- Affiliations
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
- University of Milan (IT)
- Vita-Salute San Raffaele University (IT)
- Azienda Ospedaliera San Gerardo (IT)
- Venue
- Intensive Care Medicine Experimental
- Published
- 2023-10-24
- Volume
- 11
- Issue
- S1
- Pages
- 72-72
- ISSN
- 2197-425X (ISSN-L)
- PMC
- PMC10597918
- OpenAlex
- W4387892992
- Semantic Scholar
- 2d08dbde9714232608b8b8501e89b68b0df9101e
- Cited by
- 14
- References
- 3
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 4 · 2023: 4
- FWCI
- 3.38
- Type
- journal article
- Language
- en
- Update notices
- correction (2023-12-18)
- Open access
- gold
- doi.org
- Locations
- Intensive Care Medicine Experimental (publishedVersion, cc-by)
- PubMed (publishedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion, cc-by)
- TU/e Research Portal (submittedVersion, cc-by)
- PubMed Central (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Nova Science Publishers (Nova Science Publishers, Inc.) (submittedVersion, other-oa)
- Ktisis at Cyprus University of Technology (Cyprus University of Technology) (submittedVersion, public-domain)
- Funders
- National Institute for Health and Care Research (PB-PG-0317-20045)
- Topics
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Ultrasound in Clinical Applications
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- carotid ultrasound, carotid artery diameter, probe orientation, long-axis view, short-axis view, measurement robustness, hemodynamic monitoring, cardiac surgery patients, Doppler ultrasound, intensive care monitoring, operator dependence, motion robustness
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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