Ultrasound-measured brachial artery reactive hyperemia in critically ill patients: an observational study

IF 9.3 1区医学 Q1 CRITICAL CARE MEDICINE

Critical Care Pub Date : 2025-09-25 DOI:10.1186/s13054-025-05646-7

Casey R. Storms, Tristan Bice, Jimmy Zhang, Elizabeth Levy, Tetsuro Maeda, Neha Kumar, Lijo C. Illipparambil, Amy M. K. Rovitelli, Heather Clark, Orren Wexler, Michelle Malnoske, Christina Dony, Alex Z. Fe, Rebecca Shultz, Anthony P. Pietropaoli

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Abstract

Ultrasound-measured brachial artery reactive hyperemia (RH) is independently predictive of hospital mortality in critically ill patients with sepsis. Its association with mortality is uncertain in critically ill patients in general. This was a combined case-control and prospective cohort study. Ultrasound was used to measure brachial artery reactive hyperemia in 150 critically ill patients at a single academic medical center and in 44 control subjects without acute illness. Measurements were compared in cases versus controls, septic vs. non-septic critically ill patients, and hospital survivors vs. non-survivors. Follow-up measurements were obtained 3–5 days later in a sub-sample of patients. RH was calculated as the percent change in pre- vs. post-ischemic brachial artery velocity-time integral measured by Doppler ultrasound. RH was impaired in critically ill compared to control subjects (194 [179–210] vs. 369 [314–433]%, p < 0.001; results expressed as mean [95% confidence interval]) but similar in septic compared to non-septic patients (196 [177–217] vs. 199 [170–233], p = 0.88). RH was significantly lower in hospital non-survivors compared to survivors (144 [120–173] vs. 204 [187–222], p = 0.003). Multivariable analysis showed that the difference between survivors and non-survivors was not confounded by age or comorbidities (odds ratio for hospital death = 0.26 per log unit rise in RH, 95% confidence interval = 0.08–0.83, p = 0.02). The magnitude of RH improved over 3–5 days in hospital survivors (n = 63, 204 [180–232] vs. 239 [208–275], p = 0.02), but did not change in non-survivors (n = 11, 133 [107–165] vs. 128 [75–220]. Reactive hyperemia of the brachial artery is impaired in undifferentiated critically ill patients, lower in non-survivors compared to survivors, and independently associated with hospital mortality. Brachial artery reactive hyperemia improves significantly over time in survivors but not in non-survivors.

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危重病人超声测量肱动脉反应性充血：一项观察性研究

超声测量肱动脉反应性充血（RH）是脓毒症危重患者住院死亡率的独立预测指标。在一般危重病人中，其与死亡率的关系尚不确定。这是一项病例对照和前瞻性队列研究。超声测量了同一学术医疗中心150名危重患者和44名无急性疾病的对照受试者的肱动脉反应性充血。比较了病例与对照组、脓毒症与非脓毒症重症患者、医院幸存者与非幸存者的测量结果。3-5天后在患者亚样本中进行随访测量。RH是通过多普勒超声测量的缺血前后肱动脉速度-时间积分的百分比变化来计算的。与对照组相比，危重患者RH受损（194 [179-210]vs. 369 [314-433]%, p < 0.001；结果以平均值表示[95%置信区间]），但脓毒症患者与非脓毒症患者相似（196 [177-217]vs. 199 [170-233], p = 0.88）。住院非幸存者的RH明显低于幸存者（144[120-173]对204 [187-222]，p = 0.003）。多变量分析显示，幸存者和非幸存者之间的差异不受年龄或合并症的影响（医院死亡的优势比= 0.26每对数单位RH上升，95%置信区间= 0.08-0.83,p = 0.02）。住院幸存者的RH值在3-5天内有所改善（n = 63,204[180-232]对239 [208-275]，p = 0.02），但在非幸存者中没有变化(n = 11,133[107-165]对128[75-220]。反应性肱动脉充血在未分化的危重患者中受损，在非幸存者中较幸存者低，并且与医院死亡率独立相关。随着时间的推移，幸存者的肱动脉反应性充血明显改善，而非幸存者则没有。

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来源期刊

Critical Care 医学-危重病医学

CiteScore

20.60

自引率

3.30%

发文量

348

审稿时长

1.5 months

期刊介绍： Critical Care is an esteemed international medical journal that undergoes a rigorous peer-review process to maintain its high quality standards. Its primary objective is to enhance the healthcare services offered to critically ill patients. To achieve this, the journal focuses on gathering, exchanging, disseminating, and endorsing evidence-based information that is highly relevant to intensivists. By doing so, Critical Care seeks to provide a thorough and inclusive examination of the intensive care field.