The effect of preload on Doppler systolic time in a large emergency department cohort with suspected sepsis.

Authors

Sarah Atwi, Jared Nunnally, Kristen Ugale, So Mi Ko, Jaclyn Bond, Kimberly Boozer, Raymond J Bautista, Catalina Torres, Matthew Sedillo, Daniel Lachner-Piza, Tracy Savery, Melissa Hebscher, Joseph K Eibl, Jon-Emile S Kenny, Korbin Haycock

Published in

Intensive care medicine experimental. Volume 14. Issue 1. Oct 12, 2026. Epub Oct 12, 2026.

Abstract

Change in the corrected flow time of the common carotid artery (ccFT_Δ) during a preload challenge (PC) is a surrogate for stroke volume change (SV_Δ) to infer preload responsiveness (P_R).
This is a retrospective cohort study comprising patients with suspected sepsis in a large, publicly funded, academic emergency department; no patient health information is linked to the Doppler assessments. Carotid Doppler spectrograms from a wireless, wearable critical care Doppler ultrasound system are analyzed for ccFT_Δ during a PC (either infusion of 300 mL of crystalloid over 3 min or a Trendelenburg maneuver). The primary objectives of this study are to describe the proportion of P_R patients by previously described ccFT_Δ thresholds (i.e., both 4 and 7 ms ccFT_Δ ), describe time-to-peak (TTP) ccFT_Δ, and evaluate the ability of baseline ccFT to detect ccFT_Δ during PC, using both the equations of Wodey and Bazett. Comparisons of related outcomes were adjusted for multiple comparisons using the Holm procedure, baseline ccFT discrimination was quantified using area under the receiver operating characteristic curve, and TTP was estimated using patient-level bootstrap resampling. Threshold-agnostic ccFT_Δ trajectories were additionally explored using unsupervised k-means clustering of patient-level temporal responses for both correction equations.
A PC was attempted in 4367 patients and an adequate ccFT_Δ was collected from 4,128 patients (95%). In total, 982,937 Doppler cardiac cycles are included. The median ccFT_Δ was 7.3 milliseconds (ms). 51.9% of patients had a ccFT_Δ ≥ 7 ms, while 68.6% had a ccFT_Δ ≥ 4 ms by the equation of Wodey. For Bazett, these fractions were 61.2% and 73.5%, respectively. For patients identified as P_R based upon either a 4 ms or 7 ms ccFT_Δ threshold, the time-to-peak ccFT_Δ was 27.5 s for both equations. Baseline absolute ccFT did not discriminate P_R from P_UR patients under both correction formulae (AUROC 0.56-0.57).
To our knowledge this is the largest reported dataset of ED patients with suspected sepsis receiving P_R assessments by Doppler ultrasound, comprising nearly 1 million Doppler cardiac cycles obtained from over 4100 ED patients. Both 7 ms and 4 ms ccFT_Δ thresholds described clinically-accepted rates of P_R. The TTP was roughly 30 s into PC and baseline ccFT did not accurately detect ccFT_Δ during PC. Finally, a hypothesis-generating analysis identified four distinct ccFT_Δ trajectories during PC which may represent unique preload response patterns during P_R testing.

PMID:
42862455
Bibliographic data and abstract were imported from PubMed on 13 Oct 2026.

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