Karel Huard, Olivier Lachance, Mélissa Parent, Patrick Tawil, Elena Saade, Ali Hammoud, Etienne J Couture, Yoan Lamarche, Stéphanie Jarry, Alexander Calderone, Pierre Robillard, Sylvie Levesque, William Beaubien-Souligny, André Y Denault
{"title":"心脏手术患者多普勒超声显示异常股总静脉搏动的发生率及其与不良事件的关系：一项前瞻性队列研究。","authors":"Karel Huard, Olivier Lachance, Mélissa Parent, Patrick Tawil, Elena Saade, Ali Hammoud, Etienne J Couture, Yoan Lamarche, Stéphanie Jarry, Alexander Calderone, Pierre Robillard, Sylvie Levesque, William Beaubien-Souligny, André Y Denault","doi":"10.1007/s12630-025-02911-9","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Doppler ultrasound assessment of common femoral vein (CFV) flow could represent a simple, fast, and noninvasive technique to identify right ventricular dysfunction and venous congestion in patients undergoing cardiac surgery. Our primary objective was to determine the prevalence of abnormal CFV flow pulsatility before cardiac surgery. Secondary objectives included investigating its association with postoperative outcomes.</p><p><strong>Methods: </strong>We conducted a single-centre prospective cohort study and recruited adult patients undergoing cardiac surgery with cardiopulmonary bypass. We performed pulsed-wave Doppler ultrasound assessments of CFV flow at four timepoints: before surgery, after induction of anesthesia, immediately after surgery, and on postoperative day 1. When the Doppler profile showed cardiophasic variations in velocities, abnormal pulsatility was defined as a CFV pulsatility fraction ≥ 100%. Outcomes included postoperative complications, duration of postoperative support, and the cumulative time of persistent organ dysfunction after surgery (T<sub>POD</sub>).</p><p><strong>Results: </strong>Among the 150 patients included, 30 (20%) presented abnormal CFV pulsatility (pulsatility fraction [PF] ≥ 100%) before surgery. Preoperative abnormal CFV pulsatility was associated with a higher proportion of postoperative acute kidney injury (35% vs 16%; P = 0.02), major complications (21% vs 7%; P = 0.02), and a longer duration of T<sub>POD</sub> (median [interquartile range]; 24 [9-56] hr vs 5 [3-19] hr; P < 0.001). After adjusting for the European System for Cardiac Operative Risk Evaluation II, the association between PF ≥ 100% before surgery and T<sub>POD</sub> remained statistically significant (β = 0.72; 95% confidence interval, 0.21 to 1.23; P = 0.01). An abnormal CFV Doppler was associated with higher right atrial pressure and tricuspid regurgitation.</p><p><strong>Conclusions: </strong>Abnormal CFV flow pulsatility occurred in 20% of patients before cardiac surgery and was associated with a higher rate of major postoperative complications, longer durations of postoperative support and care, and a longer cumulative time of persistent organ dysfunction after surgery.</p><p><strong>Study registration: </strong>ClinicalTrials.gov ( NCT05038267 ); first submitted 28 August 2021.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"615-626"},"PeriodicalIF":3.4000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prevalence of abnormal common femoral vein pulsatility on Doppler ultrasound in patients undergoing cardiac surgery and its association with adverse events: a prospective cohort study.\",\"authors\":\"Karel Huard, Olivier Lachance, Mélissa Parent, Patrick Tawil, Elena Saade, Ali Hammoud, Etienne J Couture, Yoan Lamarche, Stéphanie Jarry, Alexander Calderone, Pierre Robillard, Sylvie Levesque, William Beaubien-Souligny, André Y Denault\",\"doi\":\"10.1007/s12630-025-02911-9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Doppler ultrasound assessment of common femoral vein (CFV) flow could represent a simple, fast, and noninvasive technique to identify right ventricular dysfunction and venous congestion in patients undergoing cardiac surgery. Our primary objective was to determine the prevalence of abnormal CFV flow pulsatility before cardiac surgery. Secondary objectives included investigating its association with postoperative outcomes.</p><p><strong>Methods: </strong>We conducted a single-centre prospective cohort study and recruited adult patients undergoing cardiac surgery with cardiopulmonary bypass. We performed pulsed-wave Doppler ultrasound assessments of CFV flow at four timepoints: before surgery, after induction of anesthesia, immediately after surgery, and on postoperative day 1. When the Doppler profile showed cardiophasic variations in velocities, abnormal pulsatility was defined as a CFV pulsatility fraction ≥ 100%. Outcomes included postoperative complications, duration of postoperative support, and the cumulative time of persistent organ dysfunction after surgery (T<sub>POD</sub>).</p><p><strong>Results: </strong>Among the 150 patients included, 30 (20%) presented abnormal CFV pulsatility (pulsatility fraction [PF] ≥ 100%) before surgery. Preoperative abnormal CFV pulsatility was associated with a higher proportion of postoperative acute kidney injury (35% vs 16%; P = 0.02), major complications (21% vs 7%; P = 0.02), and a longer duration of T<sub>POD</sub> (median [interquartile range]; 24 [9-56] hr vs 5 [3-19] hr; P < 0.001). After adjusting for the European System for Cardiac Operative Risk Evaluation II, the association between PF ≥ 100% before surgery and T<sub>POD</sub> remained statistically significant (β = 0.72; 95% confidence interval, 0.21 to 1.23; P = 0.01). An abnormal CFV Doppler was associated with higher right atrial pressure and tricuspid regurgitation.</p><p><strong>Conclusions: </strong>Abnormal CFV flow pulsatility occurred in 20% of patients before cardiac surgery and was associated with a higher rate of major postoperative complications, longer durations of postoperative support and care, and a longer cumulative time of persistent organ dysfunction after surgery.</p><p><strong>Study registration: </strong>ClinicalTrials.gov ( NCT05038267 ); first submitted 28 August 2021.</p>\",\"PeriodicalId\":56145,\"journal\":{\"name\":\"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie\",\"volume\":\" \",\"pages\":\"615-626\"},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2025-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s12630-025-02911-9\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/3/3 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s12630-025-02911-9","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/3 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：多普勒超声评估股总静脉（CFV）血流是一种简单、快速、无创的技术，可用于识别心脏手术患者的右室功能障碍和静脉充血。我们的主要目的是确定心脏手术前CFV血流搏动异常的发生率。次要目的包括调查其与术后预后的关系。方法：我们进行了一项单中心前瞻性队列研究，招募了接受心脏手术合并体外循环的成年患者。我们在四个时间点对CFV血流进行了脉冲波多普勒超声评估：手术前、麻醉诱导后、手术后立即和术后第1天。当多普勒谱显示心期速度变化时，以CFV脉动分数≥100%为脉搏异常。结果包括术后并发症、术后支持时间和术后持续器官功能障碍累积时间（TPOD）。结果：纳入的150例患者中，30例（20%）术前出现CFV脉搏异常（脉搏分数[PF]≥100%）。术前CFV搏动异常与术后急性肾损伤的比例较高相关(35% vs 16%；P = 0.02)，严重并发症(21% vs 7%；P = 0.02)， TPOD持续时间较长(中位数[四分位数范围]；24[9-56]小时vs 5[3-19]小时；P POD仍有统计学意义(β = 0.72；95%置信区间为0.21 ~ 1.23；p = 0.01)。CFV多普勒异常与右房压升高和三尖瓣反流有关。结论：20%的心脏手术前患者发生CFV血流搏动异常，并伴有较高的术后主要并发症发生率、较长的术后支持和护理时间以及较长的术后持续器官功能障碍累积时间。研究注册：ClinicalTrials.gov (NCT05038267)；首次提交于2021年8月28日。
Prevalence of abnormal common femoral vein pulsatility on Doppler ultrasound in patients undergoing cardiac surgery and its association with adverse events: a prospective cohort study.
Purpose: Doppler ultrasound assessment of common femoral vein (CFV) flow could represent a simple, fast, and noninvasive technique to identify right ventricular dysfunction and venous congestion in patients undergoing cardiac surgery. Our primary objective was to determine the prevalence of abnormal CFV flow pulsatility before cardiac surgery. Secondary objectives included investigating its association with postoperative outcomes.
Methods: We conducted a single-centre prospective cohort study and recruited adult patients undergoing cardiac surgery with cardiopulmonary bypass. We performed pulsed-wave Doppler ultrasound assessments of CFV flow at four timepoints: before surgery, after induction of anesthesia, immediately after surgery, and on postoperative day 1. When the Doppler profile showed cardiophasic variations in velocities, abnormal pulsatility was defined as a CFV pulsatility fraction ≥ 100%. Outcomes included postoperative complications, duration of postoperative support, and the cumulative time of persistent organ dysfunction after surgery (TPOD).
Results: Among the 150 patients included, 30 (20%) presented abnormal CFV pulsatility (pulsatility fraction [PF] ≥ 100%) before surgery. Preoperative abnormal CFV pulsatility was associated with a higher proportion of postoperative acute kidney injury (35% vs 16%; P = 0.02), major complications (21% vs 7%; P = 0.02), and a longer duration of TPOD (median [interquartile range]; 24 [9-56] hr vs 5 [3-19] hr; P < 0.001). After adjusting for the European System for Cardiac Operative Risk Evaluation II, the association between PF ≥ 100% before surgery and TPOD remained statistically significant (β = 0.72; 95% confidence interval, 0.21 to 1.23; P = 0.01). An abnormal CFV Doppler was associated with higher right atrial pressure and tricuspid regurgitation.
Conclusions: Abnormal CFV flow pulsatility occurred in 20% of patients before cardiac surgery and was associated with a higher rate of major postoperative complications, longer durations of postoperative support and care, and a longer cumulative time of persistent organ dysfunction after surgery.
Study registration: ClinicalTrials.gov ( NCT05038267 ); first submitted 28 August 2021.
期刊介绍：
The Canadian Journal of Anesthesia (the Journal) is owned by the Canadian Anesthesiologists’
Society and is published by Springer Science + Business Media, LLM (New York). From the
first year of publication in 1954, the international exposure of the Journal has broadened
considerably, with articles now received from over 50 countries. The Journal is published
monthly, and has an impact Factor (mean journal citation frequency) of 2.127 (in 2012). Article
types consist of invited editorials, reports of original investigations (clinical and basic sciences
articles), case reports/case series, review articles, systematic reviews, accredited continuing
professional development (CPD) modules, and Letters to the Editor. The editorial content,
according to the mission statement, spans the fields of anesthesia, acute and chronic pain,
perioperative medicine and critical care. In addition, the Journal publishes practice guidelines
and standards articles relevant to clinicians. Articles are published either in English or in French,
according to the language of submission.
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