Assessment of fluid responsiveness using pulse pressure variation, stroke volume variation, plethysmographic variability index, central venous pressure, and inferior vena cava variation in patients undergoing mechanical ventilation: a systematic review and meta-analysis.

Autor: Chaves RCF; Department of Intensive Care, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. chavesrcf@hotmail.com.; Department of Anesthesiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. chavesrcf@hotmail.com.; Department of Pneumology, Instituto do Coração (INCOR), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. chavesrcf@hotmail.com.; MIT Critical Data, Laboratory for Computational Physiology, Harvard-MIT Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA. chavesrcf@hotmail.com.; Department of Critical Care Medicine and Anesthesiology, Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701, 5° Floor, São Paulo, SP, 05651-901, Brazil. chavesrcf@hotmail.com., Barbas CSV; Department of Intensive Care, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.; Department of Pneumology, Instituto do Coração (INCOR), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil., Queiroz VNF; Department of Anesthesiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.; Department of Anesthesiology, Takaoka Anestesia, São Paulo, SP, Brazil., Serpa Neto A; Department of Intensive Care, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Melbourne, VIC, Australia.; Department of Intensive Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia., Deliberato RO; MIT Critical Data, Laboratory for Computational Physiology, Harvard-MIT Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA.; Translational Health Intelligence and Knowledge Lab, Department of Biostatistics, Health Informatics and Data Science, University of Cincinnati, Cincinnati, OH, USA.; Division of Biomedical Informatics, Cincinnati Children's Hospital, Cincinnati, OH, USA., Pereira AJ; Department of Intensive Care, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Timenetsky KT; Department of Intensive Care, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Silva Júnior JM; Department of Intensive Care, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Takaoka F; Department of Anesthesiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.; Department of Anesthesiology, Takaoka Anestesia, São Paulo, SP, Brazil., de Backer D; Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium., Celi LA; MIT Critical Data, Laboratory for Computational Physiology, Harvard-MIT Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA., Corrêa TD; Department of Intensive Care, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2024 Aug 31; Vol. 28 (1), pp. 289. Date of Electronic Publication: 2024 Aug 31.
DOI: 10.1186/s13054-024-05078-9
Abstrakt: Importance: Maneuvers assessing fluid responsiveness before an intravascular volume expansion may limit useless fluid administration, which in turn may improve outcomes.
Objective: To describe maneuvers for assessing fluid responsiveness in mechanically ventilated patients.
Registration: The protocol was registered at PROSPERO: CRD42019146781.
Information Sources and Search: PubMed, EMBASE, CINAHL, SCOPUS, and Web of Science were search from inception to 08/08/2023.
Study Selection and Data Collection: Prospective and intervention studies were selected.
Statistical Analysis: Data for each maneuver were reported individually and data from the five most employed maneuvers were aggregated. A traditional and a Bayesian meta-analysis approach were performed.
Results: A total of 69 studies, encompassing 3185 fluid challenges and 2711 patients were analyzed. The prevalence of fluid responsiveness was 49.9%. Pulse pressure variation (PPV) was studied in 40 studies, mean threshold with 95% confidence intervals (95% CI) = 11.5 (10.5-12.4)%, and area under the receiver operating characteristics curve (AUC) with 95% CI was 0.87 (0.84-0.90). Stroke volume variation (SVV) was studied in 24 studies, mean threshold with 95% CI = 12.1 (10.9-13.3)%, and AUC with 95% CI was 0.87 (0.84-0.91). The plethysmographic variability index (PVI) was studied in 17 studies, mean threshold = 13.8 (12.3-15.3)%, and AUC was 0.88 (0.82-0.94). Central venous pressure (CVP) was studied in 12 studies, mean threshold with 95% CI = 9.0 (7.7-10.1) mmHg, and AUC with 95% CI was 0.77 (0.69-0.87). Inferior vena cava variation (∆IVC) was studied in 8 studies, mean threshold = 15.4 (13.3-17.6)%, and AUC with 95% CI was 0.83 (0.78-0.89).
Conclusions: Fluid responsiveness can be reliably assessed in adult patients under mechanical ventilation. Among the five maneuvers compared in predicting fluid responsiveness, PPV, SVV, and PVI were superior to CVP and ∆IVC. However, there is no data supporting any of the above mentioned as being the best maneuver. Additionally, other well-established tests, such as the passive leg raising test, end-expiratory occlusion test, and tidal volume challenge, are also reliable.
(© 2024. The Author(s).)
Databáze: MEDLINE
Externí odkaz: