Evidence map›Paper›PMID 40999434›Full record

Observational studyCritical care (London, England)2025

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

Casey R Storms, Tristan Bice, Jimmy Zhang, Elizabeth Levy, Tetsuro Maeda, Neha Kumar, Lijo C Illipparambil, Amy M K Rovitelli, Heather Clark, Orren Wexler and 5 more

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Critical care (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Casey R StormsDivision of Pulmonary & Critical Care Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 692, Rochester, NY, 14642-4861, USA.
Tristan BiceDivision of Pulmonary & Critical Care Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 692, Rochester, NY, 14642-4861, USA.
Jimmy ZhangDivision of Pulmonary & Critical Care Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 692, Rochester, NY, 14642-4861, USA.
Elizabeth LevyDivision of Pulmonary Allergy and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Tetsuro MaedaDivision of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, THT 422, 1900 University Boulevard, Birmingham, AL, 35294-0006, USA.
Neha KumarDivision of Pulmonary & Critical Care Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 692, Rochester, NY, 14642-4861, USA.
Lijo C IllipparambilDivision of Pulmonary & Critical Care Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 692, Rochester, NY, 14642-4861, USA.
Amy M K RovitelliDivision of Pulmonary & Critical Care Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 692, Rochester, NY, 14642-4861, USA.
Heather ClarkSection of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Medical Center Boulevard, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA.
Orren WexlerDivision of Pulmonary & Critical Care Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 692, Rochester, NY, 14642-4861, USA.
Michelle MalnoskeDivision of Pulmonary/Critical Care Department of Medicine, Arnot Health, a Member of Centralus Health, 600 Roe Avenue, Suite 4A, Elmira, NY, 14905, USA.
Christina DonyDivision of Pulmonary & Critical Care Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 692, Rochester, NY, 14642-4861, USA.
Alex Z FeDivision of Pulmonary & Critical Care Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 692, Rochester, NY, 14642-4861, USA.
Rebecca ShultzDepartment of Respiratory Care, University of Rochester Medical Center, Rochester, NY, 14642-4861, USA.
Anthony P PietropaoliDivision of Pulmonary & Critical Care Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 692, Rochester, NY, 14642-4861, USA. Anthony_Pietropaoli@urmc.rochester.edu.

Funding

Complement C1q and sepsis associated fatalitiesR01HL160723 · NHLBI · UNIVERSITY OF ROCHESTER · PI KIM, MINSOO, PIETROPAOLI, ANTHONY P · 2022 to 2025
$2.7M
American Heart Association 3CRP17110114NHLBI NIH HHS R01 HL160723NIH HHS R01 HL 160723
6 · The paper itself

Abstract

backgroundUltrasound-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.

methodsThis 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.

resultsRH 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].

conclusionsReactive 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.

Indexed as

Brachial ArteryCritical IllnessHyperemiaAgedCase-Control StudiesCohort StudiesFemaleHospital MortalityHumansMaleMiddle AgedProspective StudiesSepsisUltrasonographyCritical illnessHospital mortalityMicrocirculationSepsis

Identifiers

PMID40999434
PMCPMC12465633

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.