---
title: "Preload effects on Doppler corrected carotid flow time in ED patients with suspected sepsis"
id: "pubmed-42862455"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42862455"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42862455/"
doi: "10.1186/s40635-026-00987-1"
published_at: "2026-10-12T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Preload effects on Doppler corrected carotid flow time in ED patients with suspected sepsis
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42862455
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42862455/)
- **DOI:** [10.1186/s40635-026-00987-1](https://doi.org/10.1186%2Fs40635-026-00987-1)
- **Published At:** 2026-10-12T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Investigators conducted a retrospective cohort study in a large academic emergency department of patients with suspected sepsis; Doppler assessments were de-identified and not linked to patient health records. - The primary physiological metric was change in corrected flow time of the common carotid artery (**ccFTΔ**) measured during a **preload challenge** (PC). - Two PC maneuvers were used: infusion of 300 mL crystalloid over 3 minutes or a Trendelenburg maneuver; the wireless wearable critical-care Doppler device recorded carotid Doppler spectrograms. - Primary objectives included: report the proportion of preload-responsive patients using published **ccFTΔ** thresholds (4 ms and 7 ms), describe time-to-peak (TTP) of **ccFTΔ**, and evaluate baseline corrected flow time’s ability to predict response using the Wodey and Bazett correction equations. - Statistical approach: comparisons adjusted with the Holm procedure; baseline discrimination quantified by AUC of ROC curves; TTP estimated with patient-level bootstrap resampling. - Exploratory analysis applied unsupervised k-means clustering to patient-level temporal **ccFTΔ** trajectories for both correction equations to identify threshold-agnostic response patterns. - Enrollment details: a PC was attempted in 4,367 patients; an adequate **ccFTΔ** was captured in 4,128 patients (95% capture success). - Data volume: investigators included 982,937 Doppler cardiac cycles in the analysis. - Median observed **ccFTΔ** across the cohort was 7.3 milliseconds. - The abstract text provided cuts off mid-sentence at a reported value beginning “51.9% of pati…”, and the remainder of the results, final proportions, inferential statistics, and conclusions are not present in the source material supplied here.
## Clinical Analysis & Structured Key Points
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Front Street, Toronto, ON, M5V2Y1, Canada. satwi@flosonicsmedical.com.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#full-view-affiliation-2 "Health Sciences North Research Institute, 56 Walford Rd, Sudbury, ON, P3E 2H2, Canada. satwi@flosonicsmedical.com."), [Jared Nunnally](https://pubmed.ncbi.nlm.nih.gov/?term=Nunnally+J&cauthor_id=42862455)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#full-view-affiliation-3 "Department of Emergency Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA."), [Kristen Ugale](https://pubmed.ncbi.nlm.nih.gov/?term=Ugale+K&cauthor_id=42862455)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#full-view-affiliation-3 "Department of Emergency Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA."), [So Mi Ko](https://pubmed.ncbi.nlm.nih.gov/?term=Ko+SM&cauthor_id=42862455)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#full-view-affiliation-3 "Department of Emergency Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA."), [Jaclyn Bond](https://pubmed.ncbi.nlm.nih.gov/?term=Bond+J&cauthor_id=42862455)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#full-view-affiliation-3 "Department of Emergency Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA."), [Kimberly Boozer](https://pubmed.ncbi.nlm.nih.gov/?term=Boozer+K&cauthor_id=42862455)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#full-view-affiliation-3 "Department of Emergency Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA."), [Raymond J Bautista](https://pubmed.ncbi.nlm.nih.gov/?term=Bautista+RJ&cauthor_id=42862455)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#full-view-affiliation-3 "Department of Emergency Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA."), [Catalina Torres](https://pubmed.ncbi.nlm.nih.gov/?term=Torres+C&cauthor_id=42862455)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#full-view-affiliation-3 "Department of Emergency Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA."), [Matthew Sedillo](https://pubmed.ncbi.nlm.nih.gov/?term=Sedillo+M&cauthor_id=42862455)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#full-view-affiliation-3 "Department of Emergency Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA."), [Daniel Lachner-Piza](https://pubmed.ncbi.nlm.nih.gov/?term=Lachner-Piza+D&cauthor_id=42862455)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#full-view-affiliation-4 "Flosonics Medical, 325 W. Front Street, Toronto, ON, M5V2Y1, Canada."), [Tracy Savery](https://pubmed.ncbi.nlm.nih.gov/?term=Savery+T&cauthor_id=42862455)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#full-view-affiliation-4 "Flosonics Medical, 325 W. Front Street, Toronto, ON, M5V2Y1, Canada."), [Melissa Hebscher](https://pubmed.ncbi.nlm.nih.gov/?term=Hebscher+M&cauthor_id=42862455)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#full-view-affiliation-4 "Flosonics Medical, 325 W. Front Street, Toronto, ON, M5V2Y1, Canada."), [Joseph K Eibl](https://pubmed.ncbi.nlm.nih.gov/?term=Eibl+JK&cauthor_id=42862455)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#full-view-affiliation-4 "Flosonics Medical, 325 W. Front Street, Toronto, ON, M5V2Y1, Canada.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#full-view-affiliation-5 "Northern Ontario School of Medicine, 935 Ramsey Lake Rd, Sudbury, ON, P3E2C6, Canada.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#full-view-affiliation-6 "Health Sciences North Research Institute, 56 Walford Rd, Sudbury, ON, P3E 2H2, Canada."), [Jon-Emile S Kenny](https://pubmed.ncbi.nlm.nih.gov/?term=Kenny+JS&cauthor_id=42862455)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#full-view-affiliation-7 "Flosonics Medical, 325 W. Front Street, Toronto, ON, M5V2Y1, Canada. jon-emile@heart-lung.org.")[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#full-view-affiliation-8 "Health Sciences North Research Institute, 56 Walford Rd, Sudbury, ON, P3E 2H2, Canada. jon-emile@heart-lung.org."), [Korbin Haycock](https://pubmed.ncbi.nlm.nih.gov/?term=Haycock+K&cauthor_id=42862455)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#full-view-affiliation-3 "Department of Emergency Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA.")[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#full-view-affiliation-9 "Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA.") Affiliations Expand ### Affiliations * 1 Flosonics Medical, 325 W. Front Street, Toronto, ON, M5V2Y1, Canada. satwi@flosonicsmedical.com. * 2 Health Sciences North Research Institute, 56 Walford Rd, Sudbury, ON, P3E 2H2, Canada. satwi@flosonicsmedical.com. * 3 Department of Emergency Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA. * 4 Flosonics Medical, 325 W. Front Street, Toronto, ON, M5V2Y1, Canada. * 5 Northern Ontario School of Medicine, 935 Ramsey Lake Rd, Sudbury, ON, P3E2C6, Canada. * 6 Health Sciences North Research Institute, 56 Walford Rd, Sudbury, ON, P3E 2H2, Canada. * 7 Flosonics Medical, 325 W. Front Street, Toronto, ON, M5V2Y1, Canada. jon-emile@heart-lung.org. * 8 Health Sciences North Research Institute, 56 Walford Rd, Sudbury, ON, P3E 2H2, Canada. jon-emile@heart-lung.org. * 9 Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA. * PMID: **42862455** * DOI: [ 10.1186/s40635-026-00987-1 ](https://doi.org/10.1186/s40635-026-00987-1) Item in Clipboard # The effect of preload on Doppler systolic time in a large emergency department cohort with suspected sepsis Sarah Atwi et al. Intensive Care Med Exp. 2026. Show details Display options Display options Format Abstract PubMed PMID Intensive Care Med Exp Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Intensive+Care+Med+Exp%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Intensive+Care+Med+Exp%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42862455/) . 2026 Oct 12;14(1):135. doi: 10.1186/s40635-026-00987-1. ### Authors [Sarah Atwi](https://pubmed.ncbi.nlm.nih.gov/?term=Atwi+S&cauthor_id=42862455)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#short-view-affiliation-1 "Flosonics Medical, 325 W. Front Street, Toronto, ON, M5V2Y1, Canada. satwi@flosonicsmedical.com.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#short-view-affiliation-2 "Health Sciences North Research Institute, 56 Walford Rd, Sudbury, ON, P3E 2H2, Canada. satwi@flosonicsmedical.com."), [Jared Nunnally](https://pubmed.ncbi.nlm.nih.gov/?term=Nunnally+J&cauthor_id=42862455)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#short-view-affiliation-3 "Department of Emergency Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA."), [Kristen Ugale](https://pubmed.ncbi.nlm.nih.gov/?term=Ugale+K&cauthor_id=42862455)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#short-view-affiliation-3 "Department of Emergency Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA."), [So Mi Ko](https://pubmed.ncbi.nlm.nih.gov/?term=Ko+SM&cauthor_id=42862455)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#short-view-affiliation-3 "Department of Emergency Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA."), [Jaclyn Bond](https://pubmed.ncbi.nlm.nih.gov/?term=Bond+J&cauthor_id=42862455)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#short-view-affiliation-3 "Department of Emergency Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA."), [Kimberly Boozer](https://pubmed.ncbi.nlm.nih.gov/?term=Boozer+K&cauthor_id=42862455)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#short-view-affiliation-3 "Department of Emergency Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA."), [Raymond J Bautista](https://pubmed.ncbi.nlm.nih.gov/?term=Bautista+RJ&cauthor_id=42862455)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#short-view-affiliation-3 "Department of Emergency Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA."), [Catalina Torres](https://pubmed.ncbi.nlm.nih.gov/?term=Torres+C&cauthor_id=42862455)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#short-view-affiliation-3 "Department of Emergency Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA."), [Matthew Sedillo](https://pubmed.ncbi.nlm.nih.gov/?term=Sedillo+M&cauthor_id=42862455)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#short-view-affiliation-3 "Department of Emergency Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA."), [Daniel Lachner-Piza](https://pubmed.ncbi.nlm.nih.gov/?term=Lachner-Piza+D&cauthor_id=42862455)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#short-view-affiliation-4 "Flosonics Medical, 325 W. Front Street, Toronto, ON, M5V2Y1, Canada."), [Tracy Savery](https://pubmed.ncbi.nlm.nih.gov/?term=Savery+T&cauthor_id=42862455)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#short-view-affiliation-4 "Flosonics Medical, 325 W. Front Street, Toronto, ON, M5V2Y1, Canada."), [Melissa Hebscher](https://pubmed.ncbi.nlm.nih.gov/?term=Hebscher+M&cauthor_id=42862455)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#short-view-affiliation-4 "Flosonics Medical, 325 W. Front Street, Toronto, ON, M5V2Y1, Canada."), [Joseph K Eibl](https://pubmed.ncbi.nlm.nih.gov/?term=Eibl+JK&cauthor_id=42862455)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#short-view-affiliation-4 "Flosonics Medical, 325 W. Front Street, Toronto, ON, M5V2Y1, Canada.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#short-view-affiliation-5 "Northern Ontario School of Medicine, 935 Ramsey Lake Rd, Sudbury, ON, P3E2C6, Canada.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#short-view-affiliation-6 "Health Sciences North Research Institute, 56 Walford Rd, Sudbury, ON, P3E 2H2, Canada."), [Jon-Emile S Kenny](https://pubmed.ncbi.nlm.nih.gov/?term=Kenny+JS&cauthor_id=42862455)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#short-view-affiliation-7 "Flosonics Medical, 325 W. Front Street, Toronto, ON, M5V2Y1, Canada. jon-emile@heart-lung.org.")[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#short-view-affiliation-8 "Health Sciences North Research Institute, 56 Walford Rd, Sudbury, ON, P3E 2H2, Canada. jon-emile@heart-lung.org."), [Korbin Haycock](https://pubmed.ncbi.nlm.nih.gov/?term=Haycock+K&cauthor_id=42862455)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#short-view-affiliation-3 "Department of Emergency Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA.")[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42862455/#short-view-affiliation-9 "Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA.") ### Affiliations * 1 Flosonics Medical, 325 W. Front Street, Toronto, ON, M5V2Y1, Canada. satwi@flosonicsmedical.com. * 2 Health Sciences North Research Institute, 56 Walford Rd, Sudbury, ON, P3E 2H2, Canada. satwi@flosonicsmedical.com. * 3 Department of Emergency Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA. * 4 Flosonics Medical, 325 W. Front Street, Toronto, ON, M5V2Y1, Canada. * 5 Northern Ontario School of Medicine, 935 Ramsey Lake Rd, Sudbury, ON, P3E2C6, Canada. * 6 Health Sciences North Research Institute, 56 Walford Rd, Sudbury, ON, P3E 2H2, Canada. * 7 Flosonics Medical, 325 W. Front Street, Toronto, ON, M5V2Y1, Canada. jon-emile@heart-lung.org. * 8 Health Sciences North Research Institute, 56 Walford Rd, Sudbury, ON, P3E 2H2, Canada. jon-emile@heart-lung.org. * 9 Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA. * PMID: **42862455** * DOI: [ 10.1186/s40635-026-00987-1 ](https://doi.org/10.1186/s40635-026-00987-1) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Background:** Change in the corrected flow time of the common carotid artery (ccFTΔ) during a preload challenge (PC) is a surrogate for stroke volume change (SVΔ) to infer preload responsiveness (PR). **Methods:** 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 ccFTΔ 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 PR patients by previously described ccFTΔ thresholds (i.e., both 4 and 7 ms ccFTΔ ), describe time-to-peak (TTP) ccFTΔ, and evaluate the ability of baseline ccFT to detect ccFTΔ 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 ccFTΔ trajectories were additionally explored using unsupervised k-means clustering of patient-level temporal responses for both correction equations. **Results:** A PC was attempted in 4367 patients and an adequate ccFTΔ was collected from 4,128 patients (95%). In total, 982,937 Doppler cardiac cycles are included. The median ccFTΔ was 7.3 milliseconds (ms). 51.9% of pati
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