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Predictors of fluid responsiveness in critically ill patients mechanically ventilated at low tidal volumes: systematic review and meta-analysis.

ABSTRACT:

Introduction

Dynamic predictors of fluid responsiveness have shown good performance in mechanically ventilated patients at tidal volumes (Vt)?>?8 mL kg^-1. Nevertheless, most critically ill conditions demand lower Vt. We sought to evaluate the operative performance of several predictors of fluid responsiveness at Vt???8 mL kg^-1 by using meta-regression and subgroup analyses.

Methods

A sensitive search was conducted in the Embase and MEDLINE databases. We searched for studies prospectively assessing the operative performance of pulse pressure variation (PPV), stroke volume variation (SVV), end-expiratory occlusion test (EEOT), passive leg raising (PLR), inferior vena cava respiratory variability (?-IVC), mini-fluid challenge (m-FC), and tidal volume challenge (VtC), to predict fluid responsiveness in adult patients mechanically ventilated at Vt???8 ml kg^-1, without respiratory effort and arrhythmias, published between 1999 and 2020. Operative performance was assessed using hierarchical and bivariate analyses, while subgroup analysis was used to evaluate variations in their operative performance and sources of heterogeneity. A sensitivity analysis based on the methodological quality of the studies included (QUADAS-2) was also performed.

Results

A total of 33 studies involving 1,352 patients were included for analysis. Areas under the curve (AUC) values for predictors of fluid responsiveness were: for PPV?=?0.82, ?-IVC?=?0.86, SVV?=?0.90, m-FC?=?0.84, PLR?=?0.84, EEOT?=?0.92, and VtC?=?0.92. According to subgroup analyses, variations in methods to measure cardiac output and in turn, to classify patients as responders or non-responders significantly influence the performance of PPV and SVV (p?ConclusionMost predictors of fluid responsiveness reliably predict the response of cardiac output to volume expansion in adult patients mechanically ventilated at tidal volumes???8 ml kg^-1. Nevertheless, technical and clinical variables might clearly influence on their operative performance.

SUBMITTER: Alvarado Sanchez JI

PROVIDER: S-EPMC7870741 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Predictors of fluid responsiveness in critically ill patients mechanically ventilated at low tidal volumes: systematic review and meta-analysis.

Alvarado Sánchez Jorge Iván JI Caicedo Ruiz Juan Daniel JD Diaztagle Fernández Juan José JJ Amaya Zuñiga William Fernando WF Ospina-Tascón Gustavo Adolfo GA Cruz Martínez Luis Eduardo LE

Annals of intensive care 20210208 1

<h4>Introduction</h4>Dynamic predictors of fluid responsiveness have shown good performance in mechanically ventilated patients at tidal volumes (Vt) > 8 mL kg<sup>-1</sup>. Nevertheless, most critically ill conditions demand lower Vt. We sought to evaluate the operative performance of several predictors of fluid responsiveness at Vt ≤ 8 mL kg<sup>-1</sup> by using meta-regression and subgroup analyses.<h4>Methods</h4>A sensitive search was conducted in the Embase and MEDLINE databases. We searc ...[more]

PMID: 33555488

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Dataset Information

Predictors of fluid responsiveness in critically ill patients mechanically ventilated at low tidal volumes: systematic review and meta-analysis.

Introduction

Methods

Results

Publications

Predictors of fluid responsiveness in critically ill patients mechanically ventilated at low tidal volumes: systematic review and meta-analysis.

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