• Eun-Hee Kim, Ji-Hyun Lee, In-Kyung Song, Hee-Soo Kim, Young-Eun Jang, and Jin-Tae Kim.
• From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea (E-H-.K., J-H.L., H-S.K., Y-E.J., J-T.K.) the Department of Anesthesiology and Pain Medicine, Asan Medical Center, Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea (I.-K.S.).
• Anesthesiology. 2019 May 1; 130 (5): 719-727.

BackgroundCranial sonography is a widely used point-of-care modality in infants. The authors evaluated that the respiratory variation of the internal carotid artery blood flow peak velocity as measured using transfontanelle ultrasound can predict fluid responsiveness in infants.MethodsThis prospective observational study included 30 infants undergoing cardiac surgery. Following closure of the sternum, before and after the administration of 10ml · kg crystalloid, the respiratory variation of the aorta blood flow peak velocity, pulse pressure variation, and central venous pressure were obtained. The respiratory variation of the internal carotid artery blood flow peak velocity was measured using transfontanelle ultrasound. Response to fluid administration was defined as an increase in stroke volume index, as measured with transesophageal echocardiography, greater than 15% of baseline.ResultsSeventeen subjects (57%) were responders to volume expansion. Before fluid loading, the respiratory variation of the internal carotid artery and the aorta blood flow peak velocity (means ± SD) of the responders were 12.6 ± 3.3% and 16.0 ± 3.8%, and those of the nonresponders were 8.2 ± 3.2% and 10.9 ± 3.5%, respectively. Receiver operating characteristic curve analysis showed that the respiratory variation of the internal carotid artery and the aorta blood flow peak velocity could predict fluid responsiveness; the area under the curve was 0.828 (P < 0.0001; 95% CI, 0.647 to 0.940) and 0.86 (P = 0.0001; 95% CI, 0.684 to 0.959), respectively. The cutoff values of the respiratory variation of the internal carotid artery and the aorta blood flow peak velocity were 7.8% (sensitivity, 94%; specificity, 69%) and 13% (sensitivity, 77%; specificity, 92%), respectively.ConclusionsThe respiratory variation of the internal carotid artery blood flow peak velocity as measured using transfontanelle ultrasound predicted an increase in stroke volume in response to fluid. Further research is required to establish any wider generalizability of the results.

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