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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.
Chaves, Renato Carneiro de Freitas; Barbas, Carmen Silvia Valente; Queiroz, Veronica Neves Fialho; Serpa Neto, Ary; Deliberato, Rodrigo Octavio; Pereira, Adriano José; Timenetsky, Karina Tavares; Silva Júnior, João Manoel; Takaoka, Flávio; de Backer, Daniel; Celi, Leo Anthony; Corrêa, Thiago Domingos.
Afiliación
  • Chaves RCF; Department of Intensive Care, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. chavesrcf@hotmail.com.
  • Barbas CSV; Department of Anesthesiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. chavesrcf@hotmail.com.
  • Queiroz VNF; 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.
  • Serpa Neto A; MIT Critical Data, Laboratory for Computational Physiology, Harvard-MIT Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA. chavesrcf@hotmail.com.
  • Deliberato RO; 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.
  • Pereira AJ; Department of Intensive Care, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
  • Timenetsky KT; Department of Pneumology, Instituto do Coração (INCOR), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
  • Silva Júnior JM; Department of Anesthesiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
  • Takaoka F; Department of Anesthesiology, Takaoka Anestesia, São Paulo, SP, Brazil.
  • de Backer D; Department of Intensive Care, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
  • Celi LA; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Melbourne, VIC, Australia.
  • Corrêa TD; Department of Intensive Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia.
Crit Care ; 28(1): 289, 2024 Aug 31.
Article en En | MEDLINE | ID: mdl-39217370
ABSTRACT
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Pletismografía / Respiración Artificial / Volumen Sistólico / Vena Cava Inferior / Presión Venosa Central / Fluidoterapia Límite: Humans Idioma: En Revista: Crit Care Año: 2024 Tipo del documento: Article País de afiliación: Brasil Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Pletismografía / Respiración Artificial / Volumen Sistólico / Vena Cava Inferior / Presión Venosa Central / Fluidoterapia Límite: Humans Idioma: En Revista: Crit Care Año: 2024 Tipo del documento: Article País de afiliación: Brasil Pais de publicación: Reino Unido